Provider Demographics
NPI:1720409345
Name:WOOTTON FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:WOOTTON FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WOOTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-207-3247
Mailing Address - Street 1:680 N GERMANTOWN PKWY
Mailing Address - Street 2:STE 44
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6282
Mailing Address - Country:US
Mailing Address - Phone:901-207-3247
Mailing Address - Fax:901-207-3253
Practice Address - Street 1:680 N GERMANTOWN PKWY
Practice Address - Street 2:STE 44
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6282
Practice Address - Country:US
Practice Address - Phone:901-207-3247
Practice Address - Fax:901-207-3253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-27
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty