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General NPI Number Information
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NPI Number | 1104017003
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Entity Type | Organization
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Legal Business Name | HENRY COUNTY CHIROPRACTIC CLINIC, PC
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 212 MEMORIAL DR
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City | PARIS
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State | TN
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Zip | 38242-5416
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Country | US
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Telephone | 731-641-0605
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Fax | 731-641-4525
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Provider Business Mailing Address
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Address Line | 212 MEMORIAL DR
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City | PARIS
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State | TN
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Zip | 38242-5416
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Country | US
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Telephone | 731-641-0605
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Fax | 731-641-4525
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Authorized Official
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Title or Position | DC
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Name | DR. ROBERT WESLEY MEDLIN
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Credential | DC
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Telephone | 731-641-0605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1823
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License Number State | TN
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