Healthcare Provider Details

I. General information

NPI: 1427659523
Provider Name (Legal Business Name): CITIZEN POTAWATOMI NATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 FATHER JOE MURPHY DR
SHAWNEE OK
74801-8663
US

IV. Provider business mailing address

26 FATHER JOE MURPHY DR
SHAWNEE OK
74801-8663
US

V. Phone/Fax

Practice location:
  • Phone: 405-695-6285
  • Fax:
Mailing address:
  • Phone: 405-695-6285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AUBRY BENNETT
Title or Position: BUSINESS OFFICE COORDINATOR
Credential: CPC-A
Phone: 405-964-4025