Healthcare Provider Details

I. General information

NPI: 1811459191
Provider Name (Legal Business Name): PEAK MOVEMENT CENTRE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13816 SANTA FE CROSSING DR
EDMOND OK
73013
US

IV. Provider business mailing address

2424 CROSSING DR
EDMOND OK
73013-6959
US

V. Phone/Fax

Practice location:
  • Phone: 405-252-0282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW O'BANNON
Title or Position: MANAGER
Credential: DC
Phone: 405-315-7029