Provider Demographics
NPI:1538718440
Name:IDEAL STRUCTURAL THERAPY
Entity type:Organization
Organization Name:IDEAL STRUCTURAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-853-1734
Mailing Address - Street 1:346 NEW BYHALIA RD STE 3
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3741
Mailing Address - Country:US
Mailing Address - Phone:901-853-1734
Mailing Address - Fax:901-854-1166
Practice Address - Street 1:346 NEW BYHALIA RD STE 3
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3741
Practice Address - Country:US
Practice Address - Phone:901-853-1734
Practice Address - Fax:901-854-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty