Healthcare Provider Details

I. General information

NPI: 1154468114
Provider Name (Legal Business Name): CHIROPRACTIC MEMPHIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 SUMMER AVE
MEMPHIS TN
38122-3742
US

IV. Provider business mailing address

3675 SUMMER AVE
MEMPHIS TN
38122-3742
US

V. Phone/Fax

Practice location:
  • Phone: 901-323-3613
  • Fax: 901-454-5939
Mailing address:
  • Phone: 901-323-3613
  • Fax: 901-454-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1490
License Number StateTN

VIII. Authorized Official

Name: DR. DAVID J KELLENBERGER
Title or Position: OWNER
Credential: D.C.
Phone: 901-323-3613