MEDICARE: DRC CHIROPRACTIC LLC

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	261Q00000X	Clinic/Center	DC0000002061	TN

General Provider Information

NPI Number	:	1558651273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRC CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	8834 EATONWICK DR
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-4650
Country	:	US
Telephone Number	:	901-937-9397
Fax Number	:

Provider Business Practice Location Address
First Line	:	3189 KIRBY WHITTEN RD
Second Line	:	SUITE 104
City	:	BARTLETT
State	:	TN
Zip	:	38134-2854
Country	:	US
Telephone Number	:	901-922-5398
Fax Number	:	901-922-5538

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. MATTHEW PHILIP CORNIES
Credential	:	D.C.
Telephone Number	:	901-937-9397

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	04/14/2011

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