Provider Demographics
NPI:1093336448
Name:SPINAL CORRECTIVE CTR
Entity Type:Organization
Organization Name:SPINAL CORRECTIVE CTR
Other - Org Name:SPINAL CORRECTIVE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:LIVESAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-926-8304
Mailing Address - Street 1:306 SUNSET DR STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2492
Mailing Address - Country:US
Mailing Address - Phone:423-926-8304
Mailing Address - Fax:423-926-5976
Practice Address - Street 1:306 SUNSET DR STE 100
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2492
Practice Address - Country:US
Practice Address - Phone:423-926-8304
Practice Address - Fax:423-926-5976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-27
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty