Provider Demographics
NPI:1457679169
Name:TENN SPINE AND PERFORMANCE ENHANCEMENT CENTER
Entity Type:Organization
Organization Name:TENN SPINE AND PERFORMANCE ENHANCEMENT CENTER
Other - Org Name:TENNESSEE SPINE & PERFORMANCE ENHANCEMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-286-5421
Mailing Address - Street 1:470 COLLIER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:57862-6931
Mailing Address - Country:US
Mailing Address - Phone:865-286-5421
Mailing Address - Fax:865-286-9937
Practice Address - Street 1:470 COLLIER DRIVE
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:57862-6931
Practice Address - Country:US
Practice Address - Phone:865-286-5421
Practice Address - Fax:865-286-9937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2426111N00000X
TNDC0000002426111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty