Organization
SOUTHERN SPINE AND SPORT LLC
Active
Other names
Optimal Health Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL HOLLAND DC (HEAD CLINICIAN)
(615) 758-6422
Entity
Organization
Contact information
Practice address
2530 N MOUNT JULIET RD, MOUNT JULIET, TN 37122-3007
(615) 758-6422
(615) 758-6422
Mailing address
3055 KIRKLAND CIR, MOUNT JULIET, TN 37122-8549
(615) 758-6422
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4257004
BLUE CROSS BLUE SHIELD
TN
Enumeration date
02/20/2019
Last updated
02/20/2019
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