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General NPI Number Information
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NPI Number | 1023219946
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Entity Type | Organization
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Legal Business Name | ALLSUP CHIROPRACTIC CLINIC INC.
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 1103 E 13TH ST STE E
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City | GROVE
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State | OK
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Zip | 74344-7935
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Country | US
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Telephone | 918-787-6116
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Fax | 918-787-6996
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Provider Business Mailing Address
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Address Line | 1103 E 13TH ST STE E
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City | GROVE
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State | OK
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Zip | 74344-7935
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Country | US
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Telephone | 918-787-6116
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Fax | 918-787-6996
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL D. ALLSUP
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Credential | D.C.
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Telephone | 918-787-2112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State | OK
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