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General NPI Number Information
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NPI Number | 1487770244
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Entity Type | Individual
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Provider Name | RENWICK EDDIE TUCKER D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3540 SUMMER AVENUE 305
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City | MEMPHIS
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State | TN
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Zip | 38122-3600
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Country | US
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Telephone | 901-644-5416
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Fax | 901-323-2997
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Provider Business Mailing Address
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Address Line | 6980 LAGRANGE CIRCLE NORTH
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City | CORDOVA
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State | TN
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Zip | 38018
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Country | US
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Telephone | 901-251-2549
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1943
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License Number State | TN
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