Healthcare Provider Details

I. General information

NPI: 1942609045
Provider Name (Legal Business Name): MIDSOUTH NEUROPATHY TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 BROOKFIELD RD SUITE 101
MEMPHIS TN
38119-3860
US

IV. Provider business mailing address

1052 BROOKFIELD RD SUITE 101
MEMPHIS TN
38119-3860
US

V. Phone/Fax

Practice location:
  • Phone: 901-495-2320
  • Fax:
Mailing address:
  • Phone: 901-495-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberDC1956
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD16135
License Number StateTN

VIII. Authorized Official

Name: RICHARD CHESHIER
Title or Position: PRESIDENT
Credential:
Phone: 901-626-1412