Healthcare Provider Details

I. General information

NPI: 1750549598
Provider Name (Legal Business Name): BODY IN MOTION CHIROPRACTIC AND REHAB PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 S MAIN ST
EUFAULA OK
74432-2875
US

IV. Provider business mailing address

137 S MAIN ST
EUFAULA OK
74432-2875
US

V. Phone/Fax

Practice location:
  • Phone: 918-689-3030
  • Fax: 918-689-2525
Mailing address:
  • Phone: 918-689-3030
  • Fax: 918-689-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES THOMAS HICKMAN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 918-689-3030