Provider Demographics
NPI:1740464544
Name:CROSSVILLE FAMILY CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:CROSSVILLE FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:931-456-8880
Mailing Address - Street 1:2625 N MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-5445
Mailing Address - Country:US
Mailing Address - Phone:931-456-8880
Mailing Address - Fax:931-456-8883
Practice Address - Street 1:2625 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5445
Practice Address - Country:US
Practice Address - Phone:931-456-8880
Practice Address - Fax:931-456-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000002209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3868612OtherCIGNA