Healthcare Provider Details

I. General information

NPI: 1881819803
Provider Name (Legal Business Name): COLE CHIROPRACTIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5424 S MEMORIAL DR SUITE B-2
TULSA OK
74145-9003
US

IV. Provider business mailing address

5424 S MEMORIAL DR SUITE B-2
TULSA OK
74145-9003
US

V. Phone/Fax

Practice location:
  • Phone: 918-664-2273
  • Fax: 918-664-2204
Mailing address:
  • Phone: 918-664-2273
  • Fax: 918-664-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number3202
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3202
License Number StateOK

VIII. Authorized Official

Name: DR. CHRISTOPHER KEVIN COLE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 918-664-2273