Provider Demographics
NPI:1336525427
Name:MISSION CHIROPRACTIC
Entity Type:Organization
Organization Name:MISSION CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONSON
Authorized Official - Middle Name:HOLLIDAY
Authorized Official - Last Name:DYKSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-465-6642
Mailing Address - Street 1:206B COOL SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7291
Mailing Address - Country:US
Mailing Address - Phone:615-465-6642
Mailing Address - Fax:615-224-3593
Practice Address - Street 1:206B COOL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-7291
Practice Address - Country:US
Practice Address - Phone:615-465-6642
Practice Address - Fax:615-224-3593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000002572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherTAX ID