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General NPI Number Information
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NPI Number | 1073781795
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Entity Type | Organization
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Legal Business Name | PEERY CHIROPRACTIC CLINIC, PLLC
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 6117 S MINGO RD STE-C
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City | TULSA
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State | OK
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Zip | 74133-6315
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Country | US
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Telephone | 918-254-7779
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Fax | 918-254-7227
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Provider Business Mailing Address
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Address Line | 6117 S MINGO RD STE-C
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City | TULSA
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State | OK
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Zip | 74133-6315
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Country | US
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Telephone | 918-254-7779
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Fax | 918-254-7227
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. MARK E PEERY
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Credential | D.C.
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Telephone | 918-254-7779
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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 | 3620
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License Number State | OK
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