Provider Demographics
NPI:1902847213
Name:MEDLIN, ROBERT WESLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WESLEY
Last Name:MEDLIN
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 1:212 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5416
Mailing Address - Country:US
Mailing Address - Phone:731-641-0605
Mailing Address - Fax:731-641-4525
Practice Address - Street 1:212 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5416
Practice Address - Country:US
Practice Address - Phone:731-641-0605
Practice Address - Fax:731-641-4525
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1823111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3972138OtherROBERT W. MEDLIN, DC
TNU88241Medicare UPIN