Provider Demographics
NPI:1043482193
Name:COBURN BACK AND NECK PAIN CLINIC INC.
Entity Type:Organization
Organization Name:COBURN BACK AND NECK PAIN CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-386-0080
Mailing Address - Street 1:8099 STAGE HILLS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4064
Mailing Address - Country:US
Mailing Address - Phone:901-386-0080
Mailing Address - Fax:901-382-0089
Practice Address - Street 1:8099 STAGE HILLS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4064
Practice Address - Country:US
Practice Address - Phone:901-386-0080
Practice Address - Fax:901-382-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1351261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center