NPIMap

Organization Active NPI

Providence Chiropractic LLC

  • Chiropractor
  • Hermitage, TN
National Provider Identifier
1801426218
Registry record updated Mar 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
PROVIDENCE CHIROPRACTIC LLC
Practice address
5512 Old Hickory Blvd
Hermitage, TN 37076-2576
Phone
(615) 942-7282
NPI assigned
Jan 24, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2020

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

Authorized official

Name
Michael Shaub
Title
Owner
Phone
(615) 942-7282

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

5512 Old Hickory Blvd
Hermitage, TN 37076-2576

Mailing address

5512 Old Hickory Blvd
Hermitage, TN 37076-2576

Other identifiers 2

IdentifierTypeStateIssuer
1588639561MedicaidTN
1033421466MedicaidTN

National Provider Directory

National Provider Directory

Locations

5512 Old Hickory Blvd
Hermitage, TN 37076
Phone (615) 942-7282

NPI Registry JSON

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

{
    "created_epoch": "1579824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584662400000",
    "number": "1801426218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5512 OLD HICKORY BLVD",
            "city": "HERMITAGE",
            "state": "TN",
            "postal_code": "370762576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5512 OLD HICKORY BLVD",
            "city": "HERMITAGE",
            "state": "TN",
            "postal_code": "370762576",
            "telephone_number": "615-942-7282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-24",
        "last_updated": "2020-03-20",
        "certification_date": "2020-03-20",
        "status": "A",
        "authorized_official_last_name": "SHAUB",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-942-7282"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1588639561",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033421466",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hermitage, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2020; 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.