Provider Demographics
NPI:1275867277
Name:MOUNTAIN CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:MOUNTAIN CHIROPRACTIC, PC
Other - Org Name:PRESLEY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BUFFIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-467-0302
Mailing Address - Street 1:1919 VETERANS BOULEVARD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062
Mailing Address - Country:US
Mailing Address - Phone:504-467-0302
Mailing Address - Fax:
Practice Address - Street 1:4466 ELVIS PRESLEY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7180
Practice Address - Country:US
Practice Address - Phone:901-344-7860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty