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General NPI Number Information
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NPI Number | 1104099613
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Entity Type | Organization
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Legal Business Name | POWELL CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 04/04/2008
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Provider Practice Location Address
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Address Line | 6125 S SHERIDAN RD SUITE H
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City | TULSA
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State | OK
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Zip | 74133-4056
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Country | US
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Telephone | 918-477-7909
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Fax | 918-477-7086
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Provider Business Mailing Address
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Address Line | 6125 S SHERIDAN RD SUITE H
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City | TULSA
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State | OK
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Zip | 74133-4056
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Country | US
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Telephone | 918-477-7909
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Fax | 918-477-7086
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Authorized Official
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Title or Position | SHAREHOLDER
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Name | DR. RILEY POWELL
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Credential | D.C.
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Telephone | 918-477-7909
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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 | 3679
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License Number State | OK
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