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General NPI Number Information
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NPI Number | 1285037754
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Entity Type | Organization
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Legal Business Name | REGIONAL PAIN CENTER, LLC
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Dates
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Enumeration Date | 09/29/2014
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Last Update Date | 09/29/2014
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Provider Practice Location Address
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Address Line | 6605 STAGE RD SUITE 1
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City | MEMPHIS
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State | TN
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Zip | 38134-2808
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Country | US
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Telephone | 901-800-1336
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Fax | 901-379-8955
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Provider Business Mailing Address
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Address Line | PO BOX 908
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City | CORDOVA
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State | TN
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Zip | 38088-0908
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Country | US
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Telephone | 901-800-1336
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Fax | 901-379-8955
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Authorized Official
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Title or Position | CEO
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Name | DR. MICHAEL C HOLLIMAN
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Credential | D.C.
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Telephone | 901-800-1336
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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 | DC1282
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC1082
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT8229
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD31712
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License Number State | TN
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