Providence Health Solutions LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

PROVIDENCE HEALTH SOLUTIONS LLC

Practice address

1265 Interstate Dr
Cookeville, TN 38501-5195

Phone

(615) 942-7282

NPI assigned

Jan 29, 2020

Last updated

Jan 29, 2020By the provider in NPPES

Organization subpart

No

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

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1580256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580256000000",
    "number": "1841821873",
    "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": "1265 INTERSTATE DR",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385015195",
            "telephone_number": "615-942-7282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SOLUTIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-29",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "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": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033421466",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Zulma Adriana Presley
• Jana Price, M.ED.,SLP.CCC
• Madelaine Pruitt, CRNA
• Steven Kyle Pruitt
• Jazmine Casal Pszenitzki, MD
• Melissa M Ptak, MSN, FNP-C, CDCES
• Paul Daniel Ptak, SA-C, RSA

• Chiropractor in Cookeville, TN
• Providers in Cookeville, TN by specialty
• Chiropractor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 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.