Healthcare Provider Details

I. General information

NPI: 1639433931
Provider Name (Legal Business Name): RUPERT ALAN JAMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W BROOKHAVEN CIR
MEMPHIS TN
38117-4503
US

IV. Provider business mailing address

721 W BROOKHAVEN CIR
MEMPHIS TN
38117-4503
US

V. Phone/Fax

Practice location:
  • Phone: 901-821-0945
  • Fax: 901-255-0637
Mailing address:
  • Phone: 901-821-0945
  • Fax: 901-255-0637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number677TN
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number677TN
License Number StateTN

VIII. Authorized Official

Name: DR. RUPERT ALAN JAMES
Title or Position: PROVIDER/OWNER
Credential: DC
Phone: 901-821-0945