Healthcare Provider Details

I. General information

NPI: 1508128893
Provider Name (Legal Business Name): PERFORMANCE LIFE CHIROPRACTIC AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 N WESTERN AVE STE 245 STE 245
OKLAHOMA CITY OK
73118-4012
US

IV. Provider business mailing address

5500 N WESTERN AVE STE 245 STE 245
OKLAHOMA CITY OK
73118-4012
US

V. Phone/Fax

Practice location:
  • Phone: 405-249-7800
  • Fax:
Mailing address:
  • Phone: 405-249-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: ALLISON LEES
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 405-286-1259