Provider Demographics
NPI:1902420482
Name:KERNODLE, ELLEN (DC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:KERNODLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6708 BURNT KNOB RD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2634
Mailing Address - Country:US
Mailing Address - Phone:812-593-5484
Mailing Address - Fax:
Practice Address - Street 1:4920 PORT ROYAL RD
Practice Address - Street 2:STE C
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2856
Practice Address - Country:US
Practice Address - Phone:931-451-7230
Practice Address - Fax:931-451-7058
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor