Provider Demographics
NPI:1942609045
Name:MIDSOUTH NEUROPATHY TREATMENT CENTER
Entity Type:Organization
Organization Name:MIDSOUTH NEUROPATHY TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESHIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-626-1412
Mailing Address - Street 1:1052 BROOKFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3860
Mailing Address - Country:US
Mailing Address - Phone:901-495-2320
Mailing Address - Fax:
Practice Address - Street 1:1052 BROOKFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3860
Practice Address - Country:US
Practice Address - Phone:901-495-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1956111NN0400X
TNMD16135208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN39715691Medicare PIN
3016740Medicare PIN