MEDICARE: JAYME R GIPSON 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	111NR0400X	Rehabilitation Chiropractor	DC0000002162	TN

General Provider Information

NPI Number	:	1871611095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYME R GIPSON D.C.

Provider Business Mailing Address
First Line	:	7870 WINCHESTER RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-2307
Country	:	US
Telephone Number	:	901-230-6454
Fax Number	:

Provider Business Practice Location Address
First Line	:	7870 WINCHESTER RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-2307
Country	:	US
Telephone Number	:	901-230-6454
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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