Healthcare Provider Details

I. General information

NPI: 1184747271
Provider Name (Legal Business Name): THOMAS KOONTZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1996 EXETER RD
GERMANTOWN TN
38138-3949
US

IV. Provider business mailing address

PO BOX 381408
GERMANTOWN TN
38183-1408
US

V. Phone/Fax

Practice location:
  • Phone: 901-362-2800
  • Fax: 901-624-9782
Mailing address:
  • Phone: 901-362-2800
  • Fax: 901-624-9782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC0000001115
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: