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>> Chiropractor >> Chiropractic Providers

Registrant NPI Number: 1922037027

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
14226 S ELM ST #2 GLENPOOL, OK 74033-3525 US
Tel: 918-322-3000  Fax: 918-322-3012

Contact information for business:
PO BOX 459  GLENPOOL, OK 74033-0459 US
Tel: 918-322-3000  Fax: 918-322-3012

Registration Information:
NPI: 1922037027
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y111N00000XChiropractic Providers

Legacy codes, insurance codes and state license numbers:



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