Provider Demographics
NPI:1790966364
Name:AFFORDABLE CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:AFFORDABLE CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-949-5599
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:86 FRONTAGE ROAD
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-0936
Mailing Address - Country:US
Mailing Address - Phone:423-949-5599
Mailing Address - Fax:423-949-5585
Practice Address - Street 1:86 FRONTAGE ROAD
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-0936
Practice Address - Country:US
Practice Address - Phone:423-949-5599
Practice Address - Fax:423-949-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN0000001810261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU86071Medicare UPIN