MEDICARE: AGC NEURO, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1925	TN

General Provider Information

NPI Number	:	1710382957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGC NEURO, PLLC

Provider Business Mailing Address
First Line	:	1216 OLYMPIA PL
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-5695
Country	:	US
Telephone Number	:	615-337-5051
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 SEABOARD LN STE A10
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8221
Country	:	US
Telephone Number	:	615-661-0777
Fax Number	:	615-661-0117

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ETHAN TODD CAUGHEY
Credential	:	D.C.
Telephone Number	:	615-661-0777

Provider Enumeration Date	:	10/30/2014
Last Update Date	:	10/30/2014

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