Provider Demographics
NPI:1366758716
Name:ARD, JUSTIN KYLE (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:KYLE
Last Name:ARD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 EASTPARK DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7535
Mailing Address - Country:US
Mailing Address - Phone:615-445-7701
Mailing Address - Fax:615-445-7771
Practice Address - Street 1:104 EASTPARK DR STE 102
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7535
Practice Address - Country:US
Practice Address - Phone:615-445-7701
Practice Address - Fax:615-445-7771
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5241111N00000X
TN0000002486111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor