Provider Demographics
NPI:1215970850
Name:BAST, MICHAEL E (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:BAST
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 1:6706 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-4341
Mailing Address - Country:US
Mailing Address - Phone:901-363-5088
Mailing Address - Fax:901-363-5134
Practice Address - Street 1:6706 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4341
Practice Address - Country:US
Practice Address - Phone:901-363-5088
Practice Address - Fax:901-363-5134
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4284750OtherAETNA PROVIDER #
TN0028129OtherBCBS
TN0028129OtherBCBS
TN4284750OtherAETNA PROVIDER #