1609234657 NPI number — THE CHIRO PLACE OF COLLIERVILLE PLLC

Table of content: (NPI 1609234657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609234657 NPI number — THE CHIRO PLACE OF COLLIERVILLE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHIRO PLACE OF COLLIERVILLE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1609234657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8101 HACKS CROSS RD STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLIVE BRANCH
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38654-4032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-221-7173
Provider Business Mailing Address Fax Number:
662-932-8774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3615 S HOUSTON LEVEE RD STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLIERVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38017-9173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-221-7173
Provider Business Practice Location Address Fax Number:
901-221-7934
Provider Enumeration Date:
02/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GRANGER
Authorized Official First Name:
DENA
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
770-363-4669

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2675 , 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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