Provider Demographics
NPI:1093308066
Name:WASHINGTON, EARNICIA (DC)
Entity Type:Individual
Prefix:
First Name:EARNICIA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9278 THREAVE LN APT 304
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2498
Mailing Address - Country:US
Mailing Address - Phone:770-820-1755
Mailing Address - Fax:
Practice Address - Street 1:3615 S HOUSTON LEVEE RD
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-9192
Practice Address - Country:US
Practice Address - Phone:901-221-7173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor