Provider Demographics
NPI:1649886391
Name:BROADWAY CHIROPRACTIC & WELLNESS LLC
Entity type:Organization
Organization Name:BROADWAY CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER/CHIROPRACTICE PHYSICIA
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTEN
Authorized Official - Middle Name:ALEXANDRA
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-893-1604
Mailing Address - Street 1:272 HERITAGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:615-893-0249
Mailing Address - Fax:
Practice Address - Street 1:272 HERITAGE PARK DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:615-893-0249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty