MEDICARE: ALIGN OKLAHOMA PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4163	OTHER	OK	OKLAHOMA BOARD OFCHIROPRACTIC

General Provider Information

NPI Number	:	1699121467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALIGN OKLAHOMA PC

Provider Business Mailing Address
First Line	:	1514 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-4930
Country	:	US
Telephone Number	:	405-602-8925
Fax Number	:	405-304-3021

Provider Business Practice Location Address
First Line	:	1514 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-4930
Country	:	US
Telephone Number	:	405-602-8925
Fax Number	:	405-304-3021

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KYLE DEAN BROTHERTON
Credential	:	D.C.
Telephone Number	:	405-834-5431

Provider Enumeration Date	:	05/10/2016
Last Update Date	:	03/23/2023

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Directions to “ALIGN OKLAHOMA PC ” Practice Location

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