Provider Demographics
NPI:1417691379
Name:SHEMWELL, LOGAN TIMOTHY (DC)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:TIMOTHY
Last Name:SHEMWELL
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 1:2140 W POPLAR AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-0624
Mailing Address - Country:US
Mailing Address - Phone:901-861-1212
Mailing Address - Fax:
Practice Address - Street 1:2140 W POPLAR AVE STE 107
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0624
Practice Address - Country:US
Practice Address - Phone:901-861-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty