Healthcare Provider Details

I. General information

NPI: 1215734652
Provider Name (Legal Business Name): SHANURI DERRICOTTE SETTLES DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 TILLMAN ST STE 102
MEMPHIS TN
38111-2727
US

IV. Provider business mailing address

80 TILLMAN ST STE 102
MEMPHIS TN
38111-2727
US

V. Phone/Fax

Practice location:
  • Phone: 678-612-9091
  • Fax:
Mailing address:
  • Phone: 678-612-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1982
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: