Provider Demographics
NPI:1992953061
Name:TENN CHIROPRACTIC CLINIC, INC
Entity type:Organization
Organization Name:TENN CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:TENN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:205-621-5555
Mailing Address - Street 1:377 HUNTLEY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124
Mailing Address - Country:US
Mailing Address - Phone:205-621-5555
Mailing Address - Fax:205-621-3500
Practice Address - Street 1:377 HUNTLEY PARKWAY
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124
Practice Address - Country:US
Practice Address - Phone:205-621-5555
Practice Address - Fax:205-621-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2235261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1093740904OtherNPI
ALAB32066OtherMEDICARE ID
ALAB32066OtherMEDICARE ID