Provider Demographics
NPI:1568037208
Name:ON THE SPOT CHIROPRACTIC AND SPORTS PERFORMANCE, LLC
Entity Type:Organization
Organization Name:ON THE SPOT CHIROPRACTIC AND SPORTS PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRISCOE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS, BS
Authorized Official - Phone:812-596-1701
Mailing Address - Street 1:733A MOUNT TABOR RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2212
Mailing Address - Country:US
Mailing Address - Phone:812-596-1701
Mailing Address - Fax:812-725-0356
Practice Address - Street 1:733A MOUNT TABOR RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2212
Practice Address - Country:US
Practice Address - Phone:812-596-1701
Practice Address - Fax:812-725-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty