Healthcare Provider Details

I. General information

NPI: 1235535501
Provider Name (Legal Business Name): TSCA,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5424 S MEMORIAL DR BUILDING 3 SUITE C
TULSA OK
74145-9003
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 918-808-7725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3457
License Number StateOK

VIII. Authorized Official

Name: SCOTT T KIRKPATRICK
Title or Position: PHYSICIAN/OWNER
Credential: D.C.
Phone: 918-808-7725