Provider Demographics
NPI:1457692774
Name:SMYRNA CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:SMYRNA CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-220-6824
Mailing Address - Street 1:701 PRESIDENT PL
Mailing Address - Street 2:STE. 170
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6488
Mailing Address - Country:US
Mailing Address - Phone:615-220-6824
Mailing Address - Fax:615-220-6899
Practice Address - Street 1:701 PRESIDENT PL
Practice Address - Street 2:STE. 170
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6488
Practice Address - Country:US
Practice Address - Phone:615-220-6824
Practice Address - Fax:615-220-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN 726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty