Provider Demographics
NPI:1578570453
Name:AMODEO, STEVEN RAY (DC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:RAY
Last Name:AMODEO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:AMODEO
Other - Middle Name:CHIROPRACTIC
Other - Last Name:CLINIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38027-0726
Mailing Address - Country:US
Mailing Address - Phone:901-853-8270
Mailing Address - Fax:901-854-5193
Practice Address - Street 1:777 W POPLAR AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2592
Practice Address - Country:US
Practice Address - Phone:901-853-8270
Practice Address - Fax:901-854-5193
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC 173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0026135OtherBCBS
T74809Medicare UPIN
3671737Medicare ID - Type Unspecified