Healthcare Provider Details

I. General information

NPI: 1992772917
Provider Name (Legal Business Name): JONIS CHATZIGIANNIDIS LPED, DOMP, MT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S YALE AVE STE 608
TULSA OK
74136-7808
US

IV. Provider business mailing address

6465 S YALE AVE SUITE 608
TULSA OK
74136
US

V. Phone/Fax

Practice location:
  • Phone: 918-747-8224
  • Fax: 918-935-3499
Mailing address:
  • Phone: 918-747-8224
  • Fax: 918-296-3587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number26
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number26
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number26
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number26
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number157326
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: