Provider Demographics
NPI:1093081382
Name:EXCEPTIONAL CARE CHIROPRACTIC
Entity Type:Organization
Organization Name:EXCEPTIONAL CARE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:ANN MARIA
Authorized Official - Last Name:STYLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-587-0044
Mailing Address - Street 1:P.O. BOX 179
Mailing Address - Street 2:5620 EAST ANDREW JOHNSON HIGHWAY
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37860-0179
Mailing Address - Country:US
Mailing Address - Phone:423-587-0044
Mailing Address - Fax:423-586-5844
Practice Address - Street 1:5351 OLD KENTUCKY RD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:TN
Practice Address - Zip Code:37860-0179
Practice Address - Country:US
Practice Address - Phone:423-587-0044
Practice Address - Fax:423-586-5844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2271111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
103I357427Medicare PIN