Provider Demographics
NPI:1811649056
Name:COLLEGEDALE PHYSICAL MEDICINE, PLLC
Entity type:Organization
Organization Name:COLLEGEDALE PHYSICAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:CTA
Authorized Official - Phone:423-238-4118
Mailing Address - Street 1:9457 DAVID SMITH LN STE 103
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7201
Mailing Address - Country:US
Mailing Address - Phone:423-238-4118
Mailing Address - Fax:423-238-6565
Practice Address - Street 1:9457 DAVID SMITH LN STE 103
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-7201
Practice Address - Country:US
Practice Address - Phone:423-238-4118
Practice Address - Fax:423-238-6565
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLLEGEDALE CHIROPRACTIC PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain