Provider Demographics
NPI:1982859187
Name:CHATTANOOGA SPINE & REHABILITATION PLLC
Entity Type:Organization
Organization Name:CHATTANOOGA SPINE & REHABILITATION PLLC
Other - Org Name:SISKIN PHYSICAL MEDICINE & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-803-2226
Mailing Address - Street 1:1 SISKIN PLZ STE 101
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1306
Mailing Address - Country:US
Mailing Address - Phone:423-803-2226
Mailing Address - Fax:423-803-2222
Practice Address - Street 1:1 SISKIN PLZ STE 101
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1306
Practice Address - Country:US
Practice Address - Phone:423-803-2226
Practice Address - Fax:423-803-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370394Medicare PIN
TN6200840001Medicare NSC