Healthcare Provider Details

I. General information

NPI: 1013520733
Provider Name (Legal Business Name): CENTER FOR JOINT RELIEF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10325 GREENBRIAR PL STE B
OKLAHOMA CITY OK
73159-7647
US

IV. Provider business mailing address

10325 GREENBRIAR PL STE B
OKLAHOMA CITY OK
73159-7647
US

V. Phone/Fax

Practice location:
  • Phone: 405-759-7719
  • Fax: 405-759-7718
Mailing address:
  • Phone: 405-759-7719
  • Fax: 405-759-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON A MANNING
Title or Position: OWNER
Credential: MSPT
Phone: 405-706-1266