MEDICARE: RICKEY W. HURST D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC 300	TN

General Provider Information

NPI Number	:	1225034036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICKEY W. HURST D.C.

Provider Business Mailing Address
First Line	:	330 TOWLES AVE
Second Line	:
City	:	MCMINNVILLE
State	:	TN
Zip	:	37110-2082
Country	:	US
Telephone Number	:	931-473-7805
Fax Number	:	931-473-1939

Provider Business Practice Location Address
First Line	:	330 TOWLES AVE
Second Line	:
City	:	MCMINNVILLE
State	:	TN
Zip	:	37110-2082
Country	:	US
Telephone Number	:	931-473-7805
Fax Number	:	931-473-1939

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	09/27/2013

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Practice Location Address:

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Practice Location Address:

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1538168570 — MR. WARREN J. STOFFEY PA-C
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