Provider Demographics
NPI:1962600320
Name:SHARP, BRIAN LANE (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LANE
Last Name:SHARP
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 1:2012B MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-3914
Mailing Address - Country:US
Mailing Address - Phone:615-382-1411
Mailing Address - Fax:615-382-1414
Practice Address - Street 1:2012B MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3914
Practice Address - Country:US
Practice Address - Phone:615-382-1411
Practice Address - Fax:615-382-1414
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV03913Medicare UPIN
GA35ZCJBXMedicare ID - Type Unspecified