Provider Demographics
NPI:1770663239
Name:LOOKOUT VALLEY CHIROPRACTIC
Entity Type:Organization
Organization Name:LOOKOUT VALLEY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KJOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-825-5252
Mailing Address - Street 1:3536 CUMMINGS HWY
Mailing Address - Street 2:STE120
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37419-2435
Mailing Address - Country:US
Mailing Address - Phone:423-825-5252
Mailing Address - Fax:423-825-1228
Practice Address - Street 1:3536 CUMMINGS HWY
Practice Address - Street 2:STE120
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37419-2435
Practice Address - Country:US
Practice Address - Phone:423-825-5252
Practice Address - Fax:423-825-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1430111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA350052346OtherRAILROAD MC PALMETTO GBA
TN5011638OtherAETNA PIN
GA000933226AMedicaid
TN3069538OtherBLUE CROSS PIN
GA000933226AMedicaid
TN5011638OtherAETNA PIN
GA000933226AMedicaid