Provider Demographics
NPI:1730957028
Name:NASHVILLE CHIROPRACTIC & SPORTS PERFORMANCE LLC
Entity type:Organization
Organization Name:NASHVILLE CHIROPRACTIC & SPORTS PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:LISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-859-6644
Mailing Address - Street 1:913 CONFERENCE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1991
Mailing Address - Country:US
Mailing Address - Phone:615-859-6644
Mailing Address - Fax:
Practice Address - Street 1:913 CONFERENCE DR STE 104
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1991
Practice Address - Country:US
Practice Address - Phone:615-859-6644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty