Provider Demographics
NPI:1710382957
Name:AGC NEURO, PLLC
Entity Type:Organization
Organization Name:AGC NEURO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:CAUGHEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-661-0777
Mailing Address - Street 1:1216 OLYMPIA PL
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5695
Mailing Address - Country:US
Mailing Address - Phone:615-337-5051
Mailing Address - Fax:
Practice Address - Street 1:130 SEABOARD LN STE A10
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8221
Practice Address - Country:US
Practice Address - Phone:615-661-0777
Practice Address - Fax:615-661-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1925111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty