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General NPI Number Information
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NPI Number | 1285816462
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Entity Type | Organization
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Legal Business Name | COLE CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 417 TROY AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-3947
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Country | US
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Telephone | 731-285-2696
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Fax | 731-285-2701
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Provider Business Mailing Address
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Address Line | 417 TROY AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-3947
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Country | US
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Telephone | 731-285-2696
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Fax | 731-285-2701
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Authorized Official
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Title or Position | OWNER
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Name | DR. BARRY L COLE
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Credential | DC
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Telephone | 731-285-2696
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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 | 125
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License Number State | TN
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