Provider Demographics
NPI:1124399159
Name:HIXSON SPINE CENTER OF CHATTANOOGA,INC.
Entity Type:Organization
Organization Name:HIXSON SPINE CENTER OF CHATTANOOGA,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-877-1558
Mailing Address - Street 1:4513 HIXSON PIKE STE 104
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5039
Mailing Address - Country:US
Mailing Address - Phone:423-877-1558
Mailing Address - Fax:423-877-1543
Practice Address - Street 1:4513 HIXSON PIKE STE 104
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5039
Practice Address - Country:US
Practice Address - Phone:423-877-1558
Practice Address - Fax:423-877-1543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3970763Medicare PIN