Provider Demographics
NPI:1528215860
Name:TOTAL HEALTH CHIROPRACTIC & WELLNESS CLINIC PC
Entity Type:Organization
Organization Name:TOTAL HEALTH CHIROPRACTIC & WELLNESS CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O/DIRECT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:CLENIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-683-5971
Mailing Address - Street 1:PO BOX 17369
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-0369
Mailing Address - Country:US
Mailing Address - Phone:901-683-5971
Mailing Address - Fax:901-682-2148
Practice Address - Street 1:1069 W REX RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3866
Practice Address - Country:US
Practice Address - Phone:901-683-5971
Practice Address - Fax:901-682-2148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC431111N00000X
TNDC2105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty