1346530706 NPI number — DR. TAMEKA TANYANIQUE DANIELS D.C

Table of content: DR. TAMEKA TANYANIQUE DANIELS D.C (NPI 1346530706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346530706 NPI number — DR. TAMEKA TANYANIQUE DANIELS D.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANIELS
Provider First Name:
TAMEKA
Provider Middle Name:
TANYANIQUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346530706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3615 S HOUSTON LEVEE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLIERVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38017-9192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-221-7173
Provider Business Mailing Address Fax Number:
901-221-7934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1835 UNION AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38104-3921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-552-5461
Provider Business Practice Location Address Fax Number:
901-552-5471
Provider Enumeration Date:
04/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC0000002173 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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