Provider Demographics
NPI:1285995746
Name:PENDERGRASS CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:PENDERGRASS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:PENDERGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-499-5848
Mailing Address - Street 1:854 N MOUNT JULIET RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3391
Mailing Address - Country:US
Mailing Address - Phone:615-499-5848
Mailing Address - Fax:615-758-3437
Practice Address - Street 1:854 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3391
Practice Address - Country:US
Practice Address - Phone:615-499-5848
Practice Address - Fax:615-758-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC2521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1770841983OtherNPI TYPE 1
TN103G701269Medicare PIN