Provider Demographics
NPI:1568622967
Name:CLEVELAND NON-SURGICAL PC
Entity Type:Organization
Organization Name:CLEVELAND NON-SURGICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-473-9700
Mailing Address - Street 1:1590 CLINGAN RIDGE DR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3650
Mailing Address - Country:US
Mailing Address - Phone:423-473-9700
Mailing Address - Fax:423-473-9707
Practice Address - Street 1:1590 CLINGAN RIDGE DR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3650
Practice Address - Country:US
Practice Address - Phone:423-473-9700
Practice Address - Fax:423-473-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNDC1085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3724600Medicare PIN
TNU45810Medicare UPIN