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General NPI Number Information
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NPI Number | 1023281003
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Entity Type | Organization
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Legal Business Name | CRYSTAL CLEAR CHIROPRACTIC & REHAB
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 12831 STRATFORD DR APT. # 207
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-8495
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Country | US
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Telephone | 405-314-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 N CLASSEN BLVD SUITE P
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City | OKLAHOMA CITY
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State | OK
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Zip | 73106-5422
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Country | US
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Telephone | 405-314-0900
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. CHRIS A VANNARATH
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Credential | D.C.
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Telephone | 405-314-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 3837
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License Number State | OK
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