Provider Demographics
NPI:1881858249
Name:BRENTWOOD CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:BRENTWOOD CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-373-0276
Mailing Address - Street 1:PO BOX 2026
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-2026
Mailing Address - Country:US
Mailing Address - Phone:615-373-0276
Mailing Address - Fax:615-373-0879
Practice Address - Street 1:785 OLD HICKORY BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4512
Practice Address - Country:US
Practice Address - Phone:615-373-0276
Practice Address - Fax:615-373-0879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty