Provider Demographics
NPI:1598123705
Name:BETTS, MISTY MOORE (DC)
Entity type:Individual
Prefix:DR
First Name:MISTY
Middle Name:MOORE
Last Name:BETTS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 W POPLAR AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-0624
Mailing Address - Country:US
Mailing Address - Phone:901-861-1212
Mailing Address - Fax:901-861-1283
Practice Address - Street 1:2140 W POPLAR AVE STE 107
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0624
Practice Address - Country:US
Practice Address - Phone:901-861-1212
Practice Address - Fax:901-861-1283
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000002836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor