Provider Demographics
NPI:1508034950
Name:CROSSROADS CHIROPRACTIC PA
Entity Type:Organization
Organization Name:CROSSROADS CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-327-1551
Mailing Address - Street 1:3445 POPLAR AVE
Mailing Address - Street 2:STE 18
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4667
Mailing Address - Country:US
Mailing Address - Phone:901-327-1551
Mailing Address - Fax:901-327-1551
Practice Address - Street 1:3445 POPLAR AVE
Practice Address - Street 2:STE 18
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4667
Practice Address - Country:US
Practice Address - Phone:901-327-1551
Practice Address - Fax:901-327-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0143316OtherBLUECROSS BLUESHIELD
TN6290683OtherCIGNA HEALTHCARE
TN3676402Medicare PIN
TNU31599Medicare UPIN