Healthcare Provider Details

I. General information

NPI: 1073762381
Provider Name (Legal Business Name): OKINAKUL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11661 PRESTON RD STE 129
DALLAS TX
75230-6192
US

IV. Provider business mailing address

11661 PRESTON RD STE 129
DALLAS TX
75230-6192
US

V. Phone/Fax

Practice location:
  • Phone: 214-891-0035
  • Fax: 214-891-0033
Mailing address:
  • Phone: 214-891-0035
  • Fax: 214-891-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8872
License Number StateTX

VIII. Authorized Official

Name: DR. JASON C. ULSRUD
Title or Position: OWNER
Credential: D.C.
Phone: 214-891-0035