Provider Demographics
NPI:1154107894
Name:MULBERRY STREET CHIROPRACTIC & WELLNESS P.C.
Entity type:Organization
Organization Name:MULBERRY STREET CHIROPRACTIC & WELLNESS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-229-1456
Mailing Address - Street 1:706 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-1124
Mailing Address - Country:US
Mailing Address - Phone:865-657-9994
Mailing Address - Fax:865-657-9162
Practice Address - Street 1:706 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1124
Practice Address - Country:US
Practice Address - Phone:865-657-9994
Practice Address - Fax:865-657-9162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty