Provider Demographics
NPI:1285273433
Name:DOUGLAS, CHRISTOPHER A (DC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:A
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 WALKER RD
Mailing Address - Street 2:STE B
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7419
Mailing Address - Country:US
Mailing Address - Phone:731-592-9352
Mailing Address - Fax:
Practice Address - Street 1:429 WALKER RD
Practice Address - Street 2:STE B
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-7419
Practice Address - Country:US
Practice Address - Phone:731-592-9352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3251OtherSTATE LICENSE