Healthcare Provider Details

I. General information

NPI: 1407236094
Provider Name (Legal Business Name): MEMPHIS CHIROPRACTIC NEUROLOGY CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7981 DEXTER RD STE 101
CORDOVA TN
38016-8798
US

IV. Provider business mailing address

7981 DEXTER RD STE 101
CORDOVA TN
38016-8798
US

V. Phone/Fax

Practice location:
  • Phone: 901-752-4300
  • Fax:
Mailing address:
  • Phone: 901-752-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number StateTN

VIII. Authorized Official

Name: DR. MICHAEL ALLEN BIBB
Title or Position: DOCTOR/CO-OWNER
Credential: D.C.
Phone: 901-752-4300