Provider Demographics
NPI:1740321389
Name:HURST, JAMES E
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:HURST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 POPLAR AVE
Mailing Address - Street 2:STE 18
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4667
Mailing Address - Country:US
Mailing Address - Phone:901-327-1551
Mailing Address - Fax:901-327-1551
Practice Address - Street 1:SUITE 18
Practice Address - Street 2:3445 POPLAR AVENUE
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4667
Practice Address - Country:US
Practice Address - Phone:901-327-1551
Practice Address - Fax:901-327-1551
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC 0654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0143316OtherBLUECROSS BLUESHIELD
TN6290683OtherCIGNA HEALTHCARE
TN3676402Medicare ID - Type Unspecified
TN3676402Medicare PIN
TN0143316OtherBLUECROSS BLUESHIELD