Provider Demographics
NPI:1750833943
Name:MOUNTAIN CREEK CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MOUNTAIN CREEK CHIROPRACTIC LLC
Other - Org Name:CHRIS FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CYRUL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-266-0900
Mailing Address - Street 1:707 SIGNAL MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-1823
Mailing Address - Country:US
Mailing Address - Phone:423-266-0900
Mailing Address - Fax:423-266-0902
Practice Address - Street 1:707 SIGNAL MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-1823
Practice Address - Country:US
Practice Address - Phone:423-266-0900
Practice Address - Fax:423-266-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518247444OtherNPI
TN1316992324OtherNPI