Provider Demographics
NPI:1699188383
Name:CHATTANOOGA FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:CHATTANOOGA FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:MONTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-733-3411
Mailing Address - Street 1:7446 SHALLOWFORD RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-8815
Mailing Address - Country:US
Mailing Address - Phone:407-733-3411
Mailing Address - Fax:
Practice Address - Street 1:7446 SHALLOWFORD RD STE 204
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-8815
Practice Address - Country:US
Practice Address - Phone:407-733-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2766111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty