Provider Demographics
NPI:1073230926
Name:MOUNTAIN CREST CHIROPRACTIC
Entity Type:Organization
Organization Name:MOUNTAIN CREST CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KOLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-876-9936
Mailing Address - Street 1:205 GIFFORD PL
Mailing Address - Street 2:
Mailing Address - City:JOELTON
Mailing Address - State:TN
Mailing Address - Zip Code:37080-8669
Mailing Address - Country:US
Mailing Address - Phone:330-354-0305
Mailing Address - Fax:
Practice Address - Street 1:205 GIFFORD PL
Practice Address - Street 2:
Practice Address - City:JOELTON
Practice Address - State:TN
Practice Address - Zip Code:37080-8669
Practice Address - Country:US
Practice Address - Phone:330-354-0305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty