Provider Demographics
NPI:1922278639
Name:TOTTY CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:TOTTY CHIROPRACTIC CENTER, P.C.
Other - Org Name:HERMITAGE SPINE AND MEDICAL INSTITUTE, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:TOTTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-883-1020
Mailing Address - Street 1:4765 ANDREW JACKSON PKWY
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1301
Mailing Address - Country:US
Mailing Address - Phone:615-883-1020
Mailing Address - Fax:615-883-3895
Practice Address - Street 1:4765 ANDREW JACKSON PKWY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1301
Practice Address - Country:US
Practice Address - Phone:615-883-1020
Practice Address - Fax:615-883-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6211200001Medicare NSC