Organization
KYD KYRO
Active
Organization
KYD KYRO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER RENEE ROUSSEAU DC (OWNER/DOCTOR)
(605) 771-2700
Entity
Organization
Contact information
Practice address
390 MALLORY STATION RD, STE 103, FRANKLIN, TN 37067-8279
(605) 771-2700
(605) 771-2799
Mailing address
390 MALLORY STATION RD, STE 103, FRANKLIN, TN 37067-8279
(605) 771-2700
(605) 771-2799
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2364
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3672605
MEDICARE PTAN
TN
01
—
4281756
BCBS
TN
Enumeration date
01/25/2011
Last updated
01/25/2011
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