Provider Demographics
NPI:1427297365
Name:SPINAL PAIN RELIEF CENTER, P.C.
Entity type:Organization
Organization Name:SPINAL PAIN RELIEF CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-373-0608
Mailing Address - Street 1:1880 GENERAL GEORGE PATTON DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:615-373-0608
Mailing Address - Fax:615-373-0668
Practice Address - Street 1:1880 GENERAL GEORGE PATTON DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067
Practice Address - Country:US
Practice Address - Phone:615-373-0608
Practice Address - Fax:615-373-0668
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPINAL PAIN RELIEF CENTER, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-17
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12987363LA2100X
TN1229111N00000X
TN174400000X
TN17958208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1922139047OtherNPI
TN1922139047OtherNPI
TN36779512Medicare UPIN