MEDICARE: ELLEN KERNODLE DC

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	3295	TN

General Provider Information

NPI Number	:	1902420482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN KERNODLE DC

Provider Business Mailing Address
First Line	:	6708 BURNT KNOB RD
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37129-2634
Country	:	US
Telephone Number	:	812-593-5484
Fax Number	:

Provider Business Practice Location Address
First Line	:	4920 PORT ROYAL RD
Second Line	:	STE C
City	:	SPRING HILL
State	:	TN
Zip	:	37174-2856
Country	:	US
Telephone Number	:	931-451-7230
Fax Number	:	931-451-7058

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2020
Last Update Date	:	02/02/2021

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