Healthcare Provider Details

I. General information

NPI: 1457825465
Provider Name (Legal Business Name): OKARK CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E RAY FINE BLVD
ROLAND OK
74954-5380
US

IV. Provider business mailing address

2600 S 22ND ST
FORT SMITH AR
72901-6512
US

V. Phone/Fax

Practice location:
  • Phone: 479-522-2201
  • Fax:
Mailing address:
  • Phone:
  • 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. BERNARD TOUGAS JR.
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 479-522-2201