Provider Demographics
NPI:1639441926
Name:CLARKSVILLE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:CLARKSVILLE FAMILY CHIROPRACTIC
Other - Org Name:CLARKSVILLE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:931-647-3692
Mailing Address - Street 1:1636 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2977
Mailing Address - Country:US
Mailing Address - Phone:931-647-3692
Mailing Address - Fax:
Practice Address - Street 1:1636 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2977
Practice Address - Country:US
Practice Address - Phone:931-647-3692
Practice Address - Fax:931-647-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3970863Medicare PIN