Provider Demographics
NPI:1164784823
Name:STEWART CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:STEWART CHIROPRACTIC CENTER PC
Other - Org Name:STEWART CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-924-2668
Mailing Address - Street 1:1070 W MAIN ST
Mailing Address - Street 2:1403
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2858
Mailing Address - Country:US
Mailing Address - Phone:615-924-2668
Mailing Address - Fax:
Practice Address - Street 1:104 GLEN OAK BLVD
Practice Address - Street 2:STE 140
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-6423
Practice Address - Country:US
Practice Address - Phone:615-924-2668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty