Provider Demographics
NPI:1801897715
Name:JUSTICE, CARY TODD
Entity type:Individual
Prefix:DR
First Name:CARY
Middle Name:TODD
Last Name:JUSTICE
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 1:1160 GALLATIN RD S
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4616
Mailing Address - Country:US
Mailing Address - Phone:615-865-5251
Mailing Address - Fax:615-846-5820
Practice Address - Street 1:1160 GALLATIN RD S
Practice Address - Street 2:SUITE 109
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4616
Practice Address - Country:US
Practice Address - Phone:615-865-5251
Practice Address - Fax:615-846-5820
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
TN0000001081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN111N00000XMedicare ID - Type Unspecified