Provider Demographics
NPI:1417797226
Name:TENNESSEE MODACU, PLLC
Entity type:Organization
Organization Name:TENNESSEE MODACU, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-267-1154
Mailing Address - Street 1:1731 MALLORY LN STE 109
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7986
Mailing Address - Country:US
Mailing Address - Phone:615-552-1115
Mailing Address - Fax:
Practice Address - Street 1:1731 MALLORY LN STE 109
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7986
Practice Address - Country:US
Practice Address - Phone:615-552-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty