Healthcare Provider Details

I. General information

NPI: 1649484627
Provider Name (Legal Business Name): JAVERSAK CHIROPRACTIC & SPINE CENTER, INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 WADE WATTS AVE
MCALESTER OK
74501
US

IV. Provider business mailing address

1501 WADE WATTS AVE
MCALESTER OK
74501
US

V. Phone/Fax

Practice location:
  • Phone: 918-423-1873
  • Fax: 877-310-9896
Mailing address:
  • Phone: 918-423-1873
  • Fax: 877-310-9896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3488
License Number StateOK

VIII. Authorized Official

Name: DR. SHAYNE ANDREW JAVERSAK
Title or Position: OWNER
Credential: BS,DC
Phone: 918-423-1873