Provider Demographics
NPI:1548619497
Name:DETWEILER CHIROPRACTIC HEALTH SERVICES OF TN, PLLC
Entity Type:Organization
Organization Name:DETWEILER CHIROPRACTIC HEALTH SERVICES OF TN, PLLC
Other - Org Name:MID-SOUTH SPINE AND SPORTS PERFORMANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TYREL
Authorized Official - Middle Name:
Authorized Official - Last Name:DETWEILER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-573-2526
Mailing Address - Street 1:9740 ROYAL CHARTRES SQ N
Mailing Address - Street 2:#201
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4423
Mailing Address - Country:US
Mailing Address - Phone:901-573-2526
Mailing Address - Fax:
Practice Address - Street 1:556 TRINITY CREEK CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-2279
Practice Address - Country:US
Practice Address - Phone:901-573-2526
Practice Address - Fax:901-614-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2894111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty