Provider Demographics
NPI:1730655663
Name:MEMPHIS SPINE AND SPORT
Entity Type:Organization
Organization Name:MEMPHIS SPINE AND SPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-752-4300
Mailing Address - Street 1:1740 N GERMANTOWN PKWY STE 6
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-3308
Mailing Address - Country:US
Mailing Address - Phone:901-752-4300
Mailing Address - Fax:901-244-7072
Practice Address - Street 1:1740 N GERMANTOWN PKWY STE 6
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-3308
Practice Address - Country:US
Practice Address - Phone:901-752-4300
Practice Address - Fax:901-244-7072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty