Provider Demographics
NPI:1932476694
Name:MEMPHIS CHIROPRACTIC NEUROLOGY, INC
Entity Type:Organization
Organization Name:MEMPHIS CHIROPRACTIC NEUROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BIBB
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACNB
Authorized Official - Phone:901-210-9350
Mailing Address - Street 1:1740 N GERMANTOWN PKWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-3307
Mailing Address - Country:US
Mailing Address - Phone:901-752-4300
Mailing Address - Fax:901-752-4466
Practice Address - Street 1:1740 N GERMANTOWN PKWY
Practice Address - Street 2:SUITE 6
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-3307
Practice Address - Country:US
Practice Address - Phone:901-752-4300
Practice Address - Fax:901-752-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2114111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty