Provider Demographics
NPI:1225250699
Name:TENNESSEE SPINE AND REHAB, PLLC
Entity Type:Organization
Organization Name:TENNESSEE SPINE AND REHAB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOZZONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-954-9166
Mailing Address - Street 1:7000 LEE HWY
Mailing Address - Street 2:STE 900
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1799
Mailing Address - Country:US
Mailing Address - Phone:423-954-9166
Mailing Address - Fax:423-892-0184
Practice Address - Street 1:7000 LEE HWY
Practice Address - Street 2:STE 900
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1799
Practice Address - Country:US
Practice Address - Phone:423-954-9166
Practice Address - Fax:423-892-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001794111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty