Provider Demographics
NPI:1366624462
Name:ADVANCED CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FISHER CONSIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-443-0523
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP86115Medicare UPIN
TN3675137Medicare PIN