TRISTAR SPINE AND SPORT CHIROPRACTIC LLC
NPI 1629827159
Chiropractor in Bristol, TN

Q: What is Tristar Spine And Sport Chiropractic LLC's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Active since May 16, 2024

126 MLK JR BLVD STE A, BRISTOL, TN 37620(423) 764-2663(423) 793-1100 Get Directions Write a Review

NPPES record last updated: September 18, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 18, 2025, May 16, 2024 (2 updates tracked since 2024).

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About Tristar Spine And Sport Chiropractic Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TRISTAR SPINE AND SPORT CHIROPRACTIC LLC (NPI 1629827159) is a healthcare organization registered as a chiropractor in Bristol, Tennessee and active in the NPI registry since May 2024. The organization lists Thaddeus Keklak, Owner, Chiropractor, as its authorized official.

NPPES Registry Identity

NPI1629827159

Entity TypeOrganization

Primary Taxonomy111N00000X

Legal Business NameTRISTAR SPINE AND SPORT CHIROPRACTIC LLC

Location Address126 MLK JR BLVD STE ABristol, TN 37620-4078

Mailing Address126 Mlk Jr Blvd Ste ABristol, TN 37620-4078 · (423) 764-2663 · Fax (423) 793-1100

Phone(423) 764-2663

Fax(423) 793-1100

Organization SubpartNo

Authorized OfficialThaddeus KeklakOwner, Chiropractor · (423) 360-7366

Enumeration DateMay 16, 2024

Last NPPES UpdateSeptember 18, 20252 updates tracked since enumeration

NPPES CertifiedSeptember 18, 2025

✔ NPI 1629827159 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyChiropractorChiropractic Providers

Taxonomy Code111N00000X

Definition

A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

126 MLK JR BLVD STE A, Bristol, TN 37620

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tristar Spine And Sport Chiropractic Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Tristar Spine And Sport Chiropractic LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Thaddeus Keklak, DC

Chiropractic

NPI 1962061671

911 ANDERSON ST
Bristol, TN 37620

(423) 764-2663

✔ Accepts Medicare0.5 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tristar Spine And Sport Chiropractic LLC's NPI number?

The NPI number for Tristar Spine And Sport Chiropractic LLC is 1629827159. It was assigned to this organization in the NPPES registry on May 16, 2024.

Where is Tristar Spine And Sport Chiropractic LLC located?

Tristar Spine And Sport Chiropractic LLC is located at 126 Mlk Jr Blvd Ste A, Bristol, TN 37620. The listed phone number is (423) 764-2663.

What is Tristar Spine And Sport Chiropractic LLC's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Is Tristar Spine And Sport Chiropractic LLC enrolled in Medicare?

Yes. Tristar Spine And Sport Chiropractic LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Tristar Spine And Sport Chiropractic LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Chiropractic) reassigns their Medicare billing to Tristar Spine And Sport Chiropractic LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Tristar Spine And Sport Chiropractic LLC was last updated on September 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.