Provider Demographics
NPI:1225404205
Name:RESILIENT ASSOCIATES
Entity type:Organization
Organization Name:RESILIENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEIST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-636-5923
Mailing Address - Street 1:204 WARD CIR
Mailing Address - Street 2:STE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7551
Mailing Address - Country:US
Mailing Address - Phone:615-636-5923
Mailing Address - Fax:615-915-3187
Practice Address - Street 1:204 WARD CIR
Practice Address - Street 2:STE 300
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7551
Practice Address - Country:US
Practice Address - Phone:615-636-5923
Practice Address - Fax:615-915-3187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2649111NR0400X
TN10999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2649OtherSTATE LICENSE #
TN2134OtherSTATE LICENSE #
TN10999OtherSTATE LICENSE #