1225154396 NPI number — CHIROPRACTIC SERVICES, INC

Table of content: (NPI 1225154396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225154396 NPI number — CHIROPRACTIC SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTIC SERVICES, 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:
1225154396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 N COMMERCE ST
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
ARDMORE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73401-1438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-223-4858
Provider Business Mailing Address Fax Number:
580-226-6111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 N COMMERCE ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
ARDMORE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73401-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-223-4858
Provider Business Practice Location Address Fax Number:
580-226-6111
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
KERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMINISTRTOR
Authorized Official Telephone Number:
580-223-4858

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  1596 , 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: 526611643002 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "MEDICARE ID" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 9204749 . This is a "CIGNA" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100713340B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1689644544 . This is a "DC NPI NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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