Provider Demographics
NPI:1386839553
Name:PREMIER THERAPY OF TN
Entity Type:Organization
Organization Name:PREMIER THERAPY OF TN
Other - Org Name:MCMURTRY CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:ONEAL
Authorized Official - Last Name:MCMURTRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:931-380-1144
Mailing Address - Street 1:622 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3139
Mailing Address - Country:US
Mailing Address - Phone:931-380-1144
Mailing Address - Fax:
Practice Address - Street 1:622 W 7TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3139
Practice Address - Country:US
Practice Address - Phone:931-380-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER THERAPY OF TN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3970496Medicare PIN