Provider Demographics
NPI:1811466279
Name:THE CHIRO PLACE OF MIDTOWN PLLC
Entity type:Organization
Organization Name:THE CHIRO PLACE OF MIDTOWN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-221-7173
Mailing Address - Street 1:3615 S HOUSTON LEVEE RD
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-9192
Mailing Address - Country:US
Mailing Address - Phone:901-221-7173
Mailing Address - Fax:901-221-7934
Practice Address - Street 1:3179 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-3501
Practice Address - Country:US
Practice Address - Phone:901-221-7173
Practice Address - Fax:901-221-7934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ025029Medicaid