Provider Demographics
NPI:1922059435
Name:SHARP, DOUGLAS JOHN (D C)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOHN
Last Name:SHARP
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 GAILYNN MARIE DR
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-6034
Mailing Address - Country:US
Mailing Address - Phone:155-595-2266
Mailing Address - Fax:
Practice Address - Street 1:2012 PROVIDENCE PKWY STE A
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122
Practice Address - Country:US
Practice Address - Phone:615-559-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4406111N00000X
IN08002320A111N00000X
MI2301009686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
INV11542Medicare UPIN