Healthcare Provider Details

I. General information

NPI: 1659565778
Provider Name (Legal Business Name): COLE CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 S WHITE STATION RD
MEMPHIS TN
38117-5811
US

IV. Provider business mailing address

959 S WHITE STATION RD
MEMPHIS TN
38117-5811
US

V. Phone/Fax

Practice location:
  • Phone: 901-767-8824
  • Fax: 901-767-8822
Mailing address:
  • Phone: 901-767-8824
  • Fax: 901-767-8822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number124
License Number StateMO

VIII. Authorized Official

Name: DR. LARRY W. COLE
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 901-767-8824