Healthcare Provider Details

I. General information

NPI: 1962145441
Provider Name (Legal Business Name): CHIROPRACTIC ASSOCIATES 300, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 5TH ST
PONCA CITY OK
74601-4512
US

IV. Provider business mailing address

300 N 5TH ST
PONCA CITY OK
74601-4512
US

V. Phone/Fax

Practice location:
  • Phone: 580-762-1291
  • Fax: 580-762-1379
Mailing address:
  • Phone: 580-762-1291
  • Fax: 580-762-1379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SCOTT THOMAS KIRKPATRICK
Title or Position: LLC MEMBER
Credential: D.C.
Phone: 918-808-7725