Provider Demographics
NPI:1467986943
Name:SUMMIT FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:SUMMIT FAMILY CHIROPRACTIC LLC
Other - Org Name:TRU ROOTS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-583-9788
Mailing Address - Street 1:11227 LEBANON RD STE 1F
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-5502
Mailing Address - Country:US
Mailing Address - Phone:615-583-9788
Mailing Address - Fax:
Practice Address - Street 1:11227 LEBANON RD STE 1F
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-5502
Practice Address - Country:US
Practice Address - Phone:615-583-9788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000003006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty