Provider Demographics
NPI:1821254210
Name:WOOTTON, JARED M (DC)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:M
Last Name:WOOTTON
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 1:680 N GERMANTOWN PKWY
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor