MEDICARE: AMBER NICOLE DOUGLAS 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	DC1851	TN

General Provider Information

NPI Number	:	1760451843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER NICOLE DOUGLAS D.C.

Provider Business Mailing Address
First Line	:	PO BOX 115
Second Line	:
City	:	CAMDEN
State	:	TN
Zip	:	38320-0115
Country	:	US
Telephone Number	:	731-584-5444
Fax Number	:	731-584-4174

Provider Business Practice Location Address
First Line	:	130 HOSPITAL DR
Second Line	:
City	:	CAMDEN
State	:	TN
Zip	:	38320-1618
Country	:	US
Telephone Number	:	731-584-5444
Fax Number	:	731-584-4174

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	12/11/2009

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Directions to “ AMBER NICOLE DOUGLAS D.C.” Practice Location

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