Healthcare Provider Details

I. General information

NPI: 1407268279
Provider Name (Legal Business Name): APPLIED CHIROPRACTIC OF MEMPHIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 MADISON AVE
MEMPHIS TN
38104-2327
US

IV. Provider business mailing address

1380 MADISON AVE
MEMPHIS TN
38104-2327
US

V. Phone/Fax

Practice location:
  • Phone: 901-634-6416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number2609
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number2609
License Number StateTN

VIII. Authorized Official

Name: DR. MELODY JACKSON
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 901-634-6416