Healthcare Provider Details

I. General information

NPI: 1891492476
Provider Name (Legal Business Name): 918 CHIROPRACTIC OWASSO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 E 96TH ST N STE 200
OWASSO OK
74055-5340
US

IV. Provider business mailing address

12150 E 96TH ST N STE 200
OWASSO OK
74055-5340
US

V. Phone/Fax

Practice location:
  • Phone: 918-212-8688
  • Fax: 866-352-5122
Mailing address:
  • Phone: 918-212-8688
  • Fax: 866-352-5122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOHN MATTHEW GRISWOLD
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 918-212-8688