Provider Demographics
NPI:1104017003
Name:HENRY COUNTY CHIROPRACTIC CLINIC, PC
Entity Type:Organization
Organization Name:HENRY COUNTY CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:MEDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:731-641-0605
Mailing Address - Street 1:212 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5416
Mailing Address - Country:US
Mailing Address - Phone:731-641-0605
Mailing Address - Fax:731-641-4525
Practice Address - Street 1:212 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5416
Practice Address - Country:US
Practice Address - Phone:731-641-0605
Practice Address - Fax:731-641-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727120Medicare PIN