Provider Demographics
NPI:1114207123
Name:AMODEO CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:AMODEO CHIROPRACTIC CENTER PA
Other - Org Name:AMODEO CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:AMODEO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-853-8270
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38027-0726
Mailing Address - Country:US
Mailing Address - Phone:901-853-8270
Mailing Address - Fax:901-854-5193
Practice Address - Street 1:777 W POPLAR AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2592
Practice Address - Country:US
Practice Address - Phone:901-853-8270
Practice Address - Fax:901-854-5193
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMODEO CHIROPRACTIC CENTER, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-22
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC173332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6688660001OtherMEDICARE PTAN
TN3671737Medicare PIN
TNT74809Medicare UPIN