Provider Demographics
NPI:1124771118
Name:TENNESSEE BACK PAIN CENTER LLC
Entity type:Organization
Organization Name:TENNESSEE BACK PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-900-5187
Mailing Address - Street 1:475 SWANHOLME DR APT L209
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-1521
Mailing Address - Country:US
Mailing Address - Phone:937-825-0788
Mailing Address - Fax:
Practice Address - Street 1:3242 MEMORIAL BLVD STE C
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3233
Practice Address - Country:US
Practice Address - Phone:615-900-5187
Practice Address - Fax:833-624-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty