Healthcare Provider Details

I. General information

NPI: 1750306445
Provider Name (Legal Business Name): CULVER CLINIC OF CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 N BROADWAY ST
MARLOW OK
73055-1838
US

IV. Provider business mailing address

412 N BROADWAY ST P.O. BOX 206
MARLOW OK
73055-1838
US

V. Phone/Fax

Practice location:
  • Phone: 580-658-6604
  • Fax: 580-652-5111
Mailing address:
  • Phone: 580-658-6604
  • Fax: 580-652-5111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1367
License Number StateOK

VIII. Authorized Official

Name: DR. HAROLD RICHARD CULVER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 580-658-6604