Healthcare Provider Details

I. General information

NPI: 1164615407
Provider Name (Legal Business Name): PEACE CHIROPRACTIC CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4134 S HARVARD AVE STE B2
TULSA OK
74135-2628
US

IV. Provider business mailing address

4134 S HARVARD AVE STE B2
TULSA OK
74135-2613
US

V. Phone/Fax

Practice location:
  • Phone: 917-747-2717
  • Fax: 918-747-2718
Mailing address:
  • Phone: 917-747-2717
  • Fax: 918-747-2718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3461
License Number StateOK

VIII. Authorized Official

Name: DR. ROBERT P PEACE
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 918-747-2717