Provider Demographics
NPI:1093862922
Name:MT JULIET CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MT JULIET CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF CORP
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PROETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-758-8978
Mailing Address - Street 1:2345 N MOUNT JULIET RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3037
Mailing Address - Country:US
Mailing Address - Phone:615-758-8978
Mailing Address - Fax:615-758-8995
Practice Address - Street 1:2345 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3037
Practice Address - Country:US
Practice Address - Phone:615-758-8978
Practice Address - Fax:615-758-8995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty