Provider Demographics
NPI:1225867971
Name:SPIRIT MEDICAL, LLC
Entity type:Organization
Organization Name:SPIRIT MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CIRCOLONE
Authorized Official - Suffix:
Authorized Official - Credentials:DIANM
Authorized Official - Phone:423-855-7376
Mailing Address - Street 1:7446 SHALLOWFORD RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2352
Mailing Address - Country:US
Mailing Address - Phone:423-855-7376
Mailing Address - Fax:
Practice Address - Street 1:7446 SHALLOWFORD RD STE 108
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2352
Practice Address - Country:US
Practice Address - Phone:423-855-7376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty