Provider Demographics
NPI:1568946465
Name:BRENTWOOD ADVANCED CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BRENTWOOD ADVANCED CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:814-937-2869
Mailing Address - Street 1:5000 ARCHDALE DR APT 5202
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1781
Mailing Address - Country:US
Mailing Address - Phone:814-937-2869
Mailing Address - Fax:
Practice Address - Street 1:214 WARD CIR STE 800
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7566
Practice Address - Country:US
Practice Address - Phone:814-937-2869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty