Healthcare Provider Details

I. General information

NPI: 1770709248
Provider Name (Legal Business Name): COWETA FAMILY CHIROPRACTIC CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13783 S ST HWY 51
COWETA OK
74429-0333
US

IV. Provider business mailing address

PO BOX 333
COWETA OK
74429-0333
US

V. Phone/Fax

Practice location:
  • Phone: 918-279-1310
  • Fax: 918-279-8160
Mailing address:
  • Phone: 918-279-1310
  • Fax: 918-279-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT J MCKINNEY
Title or Position: OWNER
Credential: D.C.
Phone: 918-279-1310