Provider Demographics
NPI:1124228416
Name:MT. JULIET SPINE AND PAIN MANAGEMENT, PLLC
Entity Type:Organization
Organization Name:MT. JULIET SPINE AND PAIN MANAGEMENT, PLLC
Other - Org Name:SWIERCZ CHIROPRACTIC, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SWIERCZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-758-7575
Mailing Address - Street 1:105 INDUSTRIAL DR STE 7
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3168
Mailing Address - Country:US
Mailing Address - Phone:615-758-7575
Mailing Address - Fax:
Practice Address - Street 1:105 INDUSTRIAL DR STE 7
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3168
Practice Address - Country:US
Practice Address - Phone:615-758-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2193111N00000X
TNMD0000017958208D00000X
TNAPN0000012953363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6316630001Medicare NSC
TN36700371Medicare PIN