Provider Demographics
NPI:1538636659
Name:SKYLINE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:SKYLINE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAI'AN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-281-9100
Mailing Address - Street 1:1919 GUNBARREL RD STE 141
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4152
Mailing Address - Country:US
Mailing Address - Phone:423-281-9100
Mailing Address - Fax:
Practice Address - Street 1:1919 GUNBARREL RD STE 141
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4152
Practice Address - Country:US
Practice Address - Phone:423-281-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty