MEDICARE: MEMPHIS CHIROPRACTIC NEUROLOGY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN0400X	Neurology Chiropractor	2114	TN

General Provider Information

NPI Number	:	1932476694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMPHIS CHIROPRACTIC NEUROLOGY, INC

Provider Business Mailing Address
First Line	:	1740 N GERMANTOWN PKWY
Second Line	:	SUITE 6
City	:	CORDOVA
State	:	TN
Zip	:	38016-3307
Country	:	US
Telephone Number	:	901-752-4300
Fax Number	:	901-752-4466

Provider Business Practice Location Address
First Line	:	1740 N GERMANTOWN PKWY
Second Line	:	SUITE 6
City	:	CORDOVA
State	:	TN
Zip	:	38016-3307
Country	:	US
Telephone Number	:	901-752-4300
Fax Number	:	901-752-4466

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. MICHAEL ALLEN BIBB
Credential	:	D.C., D.A.C.N.B.
Telephone Number	:	901-210-9350

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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