Provider Demographics
NPI:1033279047
Name:PROHEALTH CHIROPRACTIC LLC
Entity type:Organization
Organization Name:PROHEALTH CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUPERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-821-0945
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-1088
Mailing Address - Country:US
Mailing Address - Phone:901-821-0945
Mailing Address - Fax:901-255-0637
Practice Address - Street 1:721 W BROOKHAVEN CIR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4503
Practice Address - Country:US
Practice Address - Phone:901-821-0945
Practice Address - Fax:901-255-0637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4440345OtherUHC
TN5280630OtherAETNA
TN3085510OtherBCBS
TN8981696OtherCIGNA
TN8981696OtherCIGNA
TN5280630OtherAETNA