Provider Demographics
NPI:1841337243
Name:RUTHERFORD CLINIC OF CHIROPRACTIC CORP
Entity type:Organization
Organization Name:RUTHERFORD CLINIC OF CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNESA
Authorized Official - Middle Name:T
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-217-0097
Mailing Address - Street 1:1139 NW BROAD ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2378
Mailing Address - Country:US
Mailing Address - Phone:615-217-0097
Mailing Address - Fax:615-848-0038
Practice Address - Street 1:1139 NW BROAD ST STE 103
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2390
Practice Address - Country:US
Practice Address - Phone:615-217-0097
Practice Address - Fax:615-848-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723876Medicare PIN
TNU86838Medicare UPIN