Healthcare Provider Details

I. General information

NPI: 1790386357
Provider Name (Legal Business Name): LAMAR DULIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
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 Number3355
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: