Provider Demographics
NPI:1326755034
Name:NC BRENTWOOD LLC
Entity Type:Organization
Organization Name:NC BRENTWOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACHINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-718-1179
Mailing Address - Street 1:7127 CROSSROADS BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7127 CROSSROADS BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2827
Practice Address - Country:US
Practice Address - Phone:615-750-2311
Practice Address - Fax:618-607-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty