1023219946 NPI number — ALLSUP CHIROPRACTIC CLINIC 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 1023219946 NPI number — ALLSUP CHIROPRACTIC CLINIC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLSUP CHIROPRACTIC CLINIC 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:
Provider Other Organization Name Type Code:
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:
1023219946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1103 E 13TH ST STE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROVE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74344-7935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-787-6116
Provider Business Mailing Address Fax Number:
918-787-6996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1103 E 13TH ST STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROVE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74344-7935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-787-6116
Provider Business Practice Location Address Fax Number:
918-787-6996
Provider Enumeration Date:
05/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALLSUP
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
918-787-2112

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , 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)





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