Provider Demographics
NPI:1558651273
Name:DRC CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DRC CHIROPRACTIC LLC
Other - Org Name:KIRBY WHITTEN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:CORNIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-937-9397
Mailing Address - Street 1:8834 EATONWICK DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-4650
Mailing Address - Country:US
Mailing Address - Phone:901-937-9397
Mailing Address - Fax:
Practice Address - Street 1:3189 KIRBY WHITTEN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2854
Practice Address - Country:US
Practice Address - Phone:901-922-5398
Practice Address - Fax:901-922-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000002061261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center