Healthcare Provider Details

I. General information

NPI: 1427521038
Provider Name (Legal Business Name): 405 CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 S SANTA FE AVE STE A
OKLAHOMA CITY OK
73139-8413
US

IV. Provider business mailing address

8901 S SANTA FE AVE STE A
OKLAHOMA CITY OK
73139-8413
US

V. Phone/Fax

Practice location:
  • Phone: 405-634-0042
  • Fax:
Mailing address:
  • Phone: 405-996-0728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. BLAKE ALAN MATLOCK
Title or Position: OWNER
Credential: DC
Phone: 405-634-0042