Healthcare Provider Details

I. General information

NPI: 1093593055
Provider Name (Legal Business Name): RENEW CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7319 NORTHSHORE DR
TUTTLE OK
73089-8994
US

IV. Provider business mailing address

7319 NORTHSHORE DR
TUTTLE OK
73089-8994
US

V. Phone/Fax

Practice location:
  • Phone: 405-237-5812
  • Fax:
Mailing address:
  • Phone: 405-237-5812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1811585037
Identifier TypeOTHER
Identifier StateOK
Identifier IssuerNPI

VIII. Authorized Official

Name: KATHERINE LOCKE
Title or Position: MANAGING MEMBER, CHIROPRACTOR
Credential: DC
Phone: 405-237-5812