Provider Demographics
NPI:1154196681
Name:REDWOOD CHIROPRACTIC, PA
Entity type:Organization
Organization Name:REDWOOD CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GENELIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-922-1292
Mailing Address - Street 1:1004 CAMPGROUND RD
Mailing Address - Street 2:
Mailing Address - City:HILHAM
Mailing Address - State:TN
Mailing Address - Zip Code:38568-6202
Mailing Address - Country:US
Mailing Address - Phone:547-922-1292
Mailing Address - Fax:
Practice Address - Street 1:28 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3334
Practice Address - Country:US
Practice Address - Phone:847-922-1292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty