Southern Spine and Sport LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

SOUTHERN SPINE AND SPORT LLC

Practice address

2530 N Mount Juliet Rd
Mount Juliet, TN 37122-3007

Phone

(615) 758-6422

Fax

(615) 758-6422

NPI assigned

Feb 20, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Daniel Holland, DC

Title

Head Clinician

Phone

(615) 758-6422

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Optimal Health Chiropractic Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550620800000",
    "number": "1366909822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3055 KIRKLAND CIR",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371228549",
            "telephone_number": "615-758-6422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 N MOUNT JULIET RD",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371223007",
            "telephone_number": "615-758-6422",
            "fax_number": "615-758-6422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN SPINE AND SPORT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-20",
        "last_updated": "2019-02-20",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "HEAD CLINICIAN",
        "authorized_official_telephone_number": "615-758-6422",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4257004",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optimal Health Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michelle Sonnichsen-Kumm
• Michelle Southard
• Southeastern Dental of Mt Juliet PLLC
• Southern Home Care Services, Inc.
• Southern Home Care Services, Inc.
• Chelsea M Sparkman, PA-C
• Nicholas Spetko III, M.D
• Jennifer L Spires, FNP-BC
• Sport Ortho Urgent Care PC
• Michelle McConnell Spradley

• Chiropractor in Mount Juliet, TN
• Providers in Mount Juliet, TN by specialty
• Chiropractor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.