Provider Demographics
NPI:1336263144
Name:SOUTH, BARRY KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:KEITH
Last Name:SOUTH
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 1:1808 BRENTWOOD PLACE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-7263
Mailing Address - Country:US
Mailing Address - Phone:615-473-4739
Mailing Address - Fax:615-333-3147
Practice Address - Street 1:4721 TROUSDALE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1322
Practice Address - Country:US
Practice Address - Phone:615-662-6500
Practice Address - Fax:615-333-3147
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0001407111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3080561OtherBLUE CROSS BLUE SHIELD
TN3679555Medicare ID - Type Unspecified
TNU69811Medicare UPIN