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General NPI Number Information
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NPI Number | 1124044615
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Entity Type | Organization
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Legal Business Name | ELITE CHIROPRACTIC PC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7107 S YALE AVE
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City | TULSA
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State | OK
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Zip | 74136
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Country | US
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Telephone | 918-610-5200
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Fax | 918-610-5325
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Provider Business Mailing Address
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Address Line | 7107 S YALE AVE #252
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City | TULSA
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State | OK
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Zip | 74136
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Country | US
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Telephone | 918-610-5200
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Fax | 918-610-5325
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. CHAD OWEN CRAIG
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Credential | DC
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Telephone | 918-610-6200
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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 | 3409
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License Number State | OK
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