Provider Demographics
NPI:1932173036
Name:POISAL, SAMUEL E IV (DC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:E
Last Name:POISAL
Suffix:IV
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 1:60 COMMERCIAL DR
Mailing Address - Street 2:ATOKA CHIROPRACTIC CLINIC
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004
Mailing Address - Country:US
Mailing Address - Phone:901-837-9320
Mailing Address - Fax:901-837-9321
Practice Address - Street 1:60 COMMERCIAL DR
Practice Address - Street 2:ATOKA CHIROPRACTIC CLINIC
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004
Practice Address - Country:US
Practice Address - Phone:901-837-9320
Practice Address - Fax:901-837-9321
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T74814Medicare UPIN
TN3671774Medicare ID - Type Unspecified