Provider Demographics
NPI:1619060779
Name:TANKERSLEY, PHILIP GLENN (DC)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:GLENN
Last Name:TANKERSLEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 CHEROKEE AVE SW STE B
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-5552
Mailing Address - Country:US
Mailing Address - Phone:256-737-9999
Mailing Address - Fax:256-739-5833
Practice Address - Street 1:2015 CHEROKEE AVE SW
Practice Address - Street 2:SUITE B
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5552
Practice Address - Country:US
Practice Address - Phone:256-737-9999
Practice Address - Fax:256-739-5833
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL70834OtherBLUE CROSS BLUE SHIELD
ALT68591Medicare UPIN
AL000070834Medicare ID - Type Unspecified