Provider Demographics
NPI:1427257740
Name:CHASTAIN FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:CHASTAIN FAMILY CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:CHASTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-942-2222
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-0910
Mailing Address - Country:US
Mailing Address - Phone:423-942-2222
Mailing Address - Fax:423-942-0200
Practice Address - Street 1:3695 MAIN ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-0417
Practice Address - Country:US
Practice Address - Phone:423-942-2222
Practice Address - Fax:423-942-0200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHASTAIN FAMILY CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty