Provider Demographics
NPI:1518127596
Name:BEWELL CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BEWELL CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HUTTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-302-2798
Mailing Address - Street 1:5083 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2771
Mailing Address - Country:US
Mailing Address - Phone:615-302-2798
Mailing Address - Fax:615-302-2785
Practice Address - Street 1:5083 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2771
Practice Address - Country:US
Practice Address - Phone:615-302-2798
Practice Address - Fax:615-302-2785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000002256111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty