Healthcare Provider Details

I. General information

NPI: 1386104727
Provider Name (Legal Business Name): JOHN CARROLL CALHOUN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 GARTH BROOKS BLVD STE 115
YUKON OK
73099-7442
US

IV. Provider business mailing address

2951 DOUGHERTY FERRY RD STE 104
SAINT LOUIS MO
63122-3373
US

V. Phone/Fax

Practice location:
  • Phone: 405-494-0165
  • Fax: 405-900-7044
Mailing address:
  • Phone: 636-556-0256
  • Fax: 636-552-4802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2017023045
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4442
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: