Provider Demographics
NPI:1225034036
Name:HURST, RICKEY W (DC)
Entity Type:Individual
Prefix:
First Name:RICKEY
Middle Name:W
Last Name:HURST
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 TOWLES AVE
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-2082
Mailing Address - Country:US
Mailing Address - Phone:931-473-7805
Mailing Address - Fax:931-473-1939
Practice Address - Street 1:330 TOWLES AVE
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2082
Practice Address - Country:US
Practice Address - Phone:931-473-7805
Practice Address - Fax:931-473-1939
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC 300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT74517Medicare UPIN
TN3672460Medicare ID - Type UnspecifiedCHIROPRACTOR