Provider Demographics
NPI:1831369370
Name:TOTTY CHIROPRACTIC OF MT. JULIET, PLLC
Entity type:Organization
Organization Name:TOTTY CHIROPRACTIC OF MT. JULIET, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:TOTTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-525-7005
Mailing Address - Street 1:541 N MOUNT JULIET RD
Mailing Address - Street 2:SUITE 2101
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3312
Mailing Address - Country:US
Mailing Address - Phone:615-758-7101
Mailing Address - Fax:615-758-7102
Practice Address - Street 1:541 N MOUNT JULIET RD
Practice Address - Street 2:SUITE 2101
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3312
Practice Address - Country:US
Practice Address - Phone:615-758-7101
Practice Address - Fax:615-758-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2172261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center