Provider Demographics
NPI:1427329424
Name:GERMANTOWN CHIROPRACTIC CLINIC PLLC
Entity type:Organization
Organization Name:GERMANTOWN CHIROPRACTIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:JESSOP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-757-9000
Mailing Address - Street 1:2121 S GERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3866
Mailing Address - Country:US
Mailing Address - Phone:901-757-9000
Mailing Address - Fax:901-755-9605
Practice Address - Street 1:2121 S GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3866
Practice Address - Country:US
Practice Address - Phone:901-757-9000
Practice Address - Fax:901-755-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC2287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty