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Organization
MEMPHIS PAIN MANAGEMENT GROUP, PC
Active
Organization
MEMPHIS PAIN MANAGEMENT GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL D RADICAN (PRESIDENT)
(901) 682-5335
Entity
Organization
Contact information
Practice address
6100 PRIMACY PKWY, SUITE 112, MEMPHIS, TN 38119-0705
(901) 682-5335
Mailing address
6100 PRIMACY PKWY, SUITE 112, MEMPHIS, TN 38119-0705
(901) 682-5335
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
DC1171
TN
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
MD430532
TN
Other
Enumeration date
04/14/2011
Last updated
05/31/2013
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