MEDICARE: LOOKOUT VALLEY CHIROPRACTIC

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	111NS0005X	Sports Physician Chiropractor	1430	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	350052346	OTHER	GA	RAILROAD MC PALMETTO GBA
2	5011638	OTHER	TN	AETNA PIN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3069538	OTHER	TN	BLUE CROSS PIN

General Provider Information

NPI Number	:	1770663239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOOKOUT VALLEY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	3536 CUMMINGS HWY
Second Line	:	STE120
City	:	CHATTANOOGA
State	:	TN
Zip	:	37419-2435
Country	:	US
Telephone Number	:	423-825-5252
Fax Number	:	423-825-1228

Provider Business Practice Location Address
First Line	:	3536 CUMMINGS HWY
Second Line	:	STE120
City	:	CHATTANOOGA
State	:	TN
Zip	:	37419-2435
Country	:	US
Telephone Number	:	423-825-5252
Fax Number	:	423-825-1228

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	MR. NEIL J KJOS
Credential	:	D.C.
Telephone Number	:	423-825-5252

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	11/30/2010

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Directions to “LOOKOUT VALLEY CHIROPRACTIC ” Practice Location

Language	Start Address	Practice Location

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