Healthcare Provider Details

I. General information

NPI: 1811019516
Provider Name (Legal Business Name): CAUGHEY CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 POPLAR AVE STE 103
MEMPHIS TN
38119-4711
US

IV. Provider business mailing address

6300 POPLAR AVE STE 103
MEMPHIS TN
38119-4711
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-1007
  • Fax: 901-682-3155
Mailing address:
  • Phone: 901-761-1007
  • Fax: 901-682-3155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1925
License Number StateTN

VIII. Authorized Official

Name: DR. ETHAN TODD CAUGHEY
Title or Position: CHIEF MANAGER
Credential: D.C.
Phone: 901-761-1007