Provider Demographics
NPI:1558726406
Name:12 SOUTH CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:12 SOUTH CHIROPRACTIC, LLC
Other - Org Name:ART OF HEALTH CHIROPRACTIC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BUCZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-953-7544
Mailing Address - Street 1:2823 BRANSFORD AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3101
Mailing Address - Country:US
Mailing Address - Phone:615-953-7544
Mailing Address - Fax:888-557-2195
Practice Address - Street 1:2823 BRANSFORD AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3101
Practice Address - Country:US
Practice Address - Phone:615-953-7544
Practice Address - Fax:888-557-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-19
Last Update Date:2015-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty