Provider Demographics
NPI:1689790362
Name:DR. MICHAEL E. BAST
Entity Type:Organization
Organization Name:DR. MICHAEL E. BAST
Other - Org Name:BAST CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-363-5088
Mailing Address - Street 1:6706 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-4341
Mailing Address - Country:US
Mailing Address - Phone:901-363-5088
Mailing Address - Fax:901-363-5134
Practice Address - Street 1:6706 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4341
Practice Address - Country:US
Practice Address - Phone:901-363-5088
Practice Address - Fax:901-363-5134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN0360261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center