Provider Demographics
NPI:1659694685
Name:TULLAHOMA CHIROPRACTIC AND MEDICAL CENTER
Entity Type:Organization
Organization Name:TULLAHOMA CHIROPRACTIC AND MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:KANAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:931-393-2401
Mailing Address - Street 1:1940 N JACKSON ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-8254
Mailing Address - Country:US
Mailing Address - Phone:931-393-2401
Mailing Address - Fax:931-393-2402
Practice Address - Street 1:1940 N JACKSON ST
Practice Address - Street 2:SUITE 110
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-8254
Practice Address - Country:US
Practice Address - Phone:931-393-2401
Practice Address - Fax:931-393-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2217111N00000X
TN14261363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty