Healthcare Provider Details

I. General information

NPI: 1992874721
Provider Name (Legal Business Name): RUPERT ALAN JAMES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5570 MURRAY RD
MEMPHIS TN
38119-3805
US

IV. Provider business mailing address

PO BOX 1088
CORDOVA TN
38088-1088
US

V. Phone/Fax

Practice location:
  • Phone: 901-821-0945
  • Fax: 901-821-0965
Mailing address:
  • Phone: 901-821-0945
  • Fax: 901-821-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number677
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number677
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: