Healthcare Provider Details

I. General information

NPI: 1619349388
Provider Name (Legal Business Name): BACK AND NECK SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 S WHITE STATION RD
MEMPHIS TN
38117-5811
US

IV. Provider business mailing address

959 S WHITE STATION RD
MEMPHIS TN
38117-5811
US

V. Phone/Fax

Practice location:
  • Phone: 901-767-8825
  • Fax: 901-767-8822
Mailing address:
  • Phone: 901-767-8825
  • Fax: 901-767-8822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2480
License Number StateTN

VIII. Authorized Official

Name: DR. LINCOLN J COLE
Title or Position: OWNER
Credential: D.C.
Phone: 901-767-8825