1730269648 NPI number — CHIROPLUS PC INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730269648 NPI number — CHIROPLUS PC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPLUS PC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MAY AVENUE CHIROPRACTIC PC INC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730269648
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10495 N MAY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73120-2610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-755-0585
Provider Business Mailing Address Fax Number:
405-755-0544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10495 N MAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73120-2610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-755-0585
Provider Business Practice Location Address Fax Number:
405-755-0544
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
LEN
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
405-755-0585

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3243 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 067542354004 . This is a "BLUECROSS BLUESHIELD ID" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com