Provider Demographics
NPI:1346309184
Name:CONSIGLIO, MAURICE (DC)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:
Last Name:CONSIGLIO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3189
Mailing Address - Country:US
Mailing Address - Phone:615-443-0523
Mailing Address - Fax:615-453-3536
Practice Address - Street 1:1606 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3189
Practice Address - Country:US
Practice Address - Phone:615-443-0523
Practice Address - Fax:615-453-3536
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3065179OtherBLUECROSS BLUESHIELD OFTN