MEDICARE: FIT SPA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3986	OK

General Provider Information

NPI Number	:	1073822565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIT SPA, LLC

Provider Business Mailing Address
First Line	:	6446 AVONDALE DR
Second Line	:
City	:	NICHOLS HILLS
State	:	OK
Zip	:	73116-6404
Country	:	US
Telephone Number	:	405-286-1259
Fax Number	:	405-286-2441

Provider Business Practice Location Address
First Line	:	6446 AVONDALE DR
Second Line	:
City	:	NICHOLS HILLS
State	:	OK
Zip	:	73116-6404
Country	:	US
Telephone Number	:	405-286-1259
Fax Number	:	405-286-2441

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	ALLISON LEES
Credential	:	DC
Telephone Number	:	405-286-1259

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	05/14/2021

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Directions to “FIT SPA, LLC ” Practice Location

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