Provider Demographics
NPI:1639182504
Name:GREEN HILLS CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:GREEN HILLS CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-383-0244
Mailing Address - Street 1:2303 CRESTMOOR RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2003
Mailing Address - Country:US
Mailing Address - Phone:615-383-0244
Mailing Address - Fax:615-386-3752
Practice Address - Street 1:2303 CRESTMOOR RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2003
Practice Address - Country:US
Practice Address - Phone:615-383-0244
Practice Address - Fax:615-386-3752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3731732Medicare ID - Type Unspecified