=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922479351
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIDTOWN CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2015
-----------------------------------------------------
Last Update Date | 10/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204 N EVERGREEN ST
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38112-5210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-726-4523
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 N EVERGREEN ST
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38112-5210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-726-4523
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LINDSEY CARR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-726-4523
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2333
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------