Provider Demographics
NPI:1437306404
Name:LAKELAND CHIROPRACTIC CLINIC PLLC
Entity Type:Organization
Organization Name:LAKELAND CHIROPRACTIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:JESSOP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-388-0737
Mailing Address - Street 1:8950 US HIGHWAY 64
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4566
Mailing Address - Country:US
Mailing Address - Phone:901-388-0737
Mailing Address - Fax:901-755-9605
Practice Address - Street 1:8950 US HIGHWAY 64
Practice Address - Street 2:SUITE 109
Practice Address - City:LAKELAND
Practice Address - State:TN
Practice Address - Zip Code:38002-4566
Practice Address - Country:US
Practice Address - Phone:901-388-0737
Practice Address - Fax:901-755-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty