Healthcare Provider Details

I. General information

NPI: 1225154396
Provider Name (Legal Business Name): CHIROPRACTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N COMMERCE ST SUITE 103
ARDMORE OK
73401-1438
US

IV. Provider business mailing address

2400 N COMMERCE ST SUITE 103
ARDMORE OK
73401-1438
US

V. Phone/Fax

Practice location:
  • Phone: 580-223-4858
  • Fax: 580-226-6111
Mailing address:
  • Phone: 580-223-4858
  • Fax: 580-226-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number1596
License Number StateOK

VIII. Authorized Official

Name: MRS. KERRY ELLIS
Title or Position: OFFICE ADMINISTRTOR
Credential:
Phone: 580-223-4858