1659540938 NPI number — ROSS CHIROPRACTIC CLINIC, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659540938 NPI number — ROSS CHIROPRACTIC CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSS CHIROPRACTIC CLINIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659540938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7405 SHALLOWFORD RD
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37421-2661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-954-9591
Provider Business Mailing Address Fax Number:
423-954-3081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7405 SHALLOWFORD RD.
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37421-2662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-954-9591
Provider Business Practice Location Address Fax Number:
423-954-3081
Provider Enumeration Date:
02/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
423-954-9591

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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