Provider Demographics
NPI:1407249741
Name:CHIROPRACTIC HEALTH AND REHABILITATION, PLLC.
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTH AND REHABILITATION, PLLC.
Other - Org Name:CHIROPRACTIC HEALTH & REHABILITATION OF MURFREESBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONSOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-624-9052
Mailing Address - Street 1:755 SAINT ANDREWS DR APT 7-101
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-6556
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:835 N THOMPSON LN
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4319
Practice Address - Country:US
Practice Address - Phone:615-624-9052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK107220Medicaid
TNQ010398Medicaid