Organization
PROVIDENCE CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL SHAUB (OWNER)
(615) 942-7282
Entity
Organization
Contact information
Practice address
5512 OLD HICKORY BLVD, HERMITAGE, TN 37076-2576
(615) 942-7282
Mailing address
5512 OLD HICKORY BLVD, HERMITAGE, TN 37076-2576
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033421466
—
TN
05
—
1588639561
—
TN
Enumeration date
01/24/2020
Last updated
03/20/2020
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