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General NPI Number Information
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NPI Number | 1154948073
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Entity Type | Organization
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Legal Business Name | THRIVE CHIROPRACTIC GROUP 3 LLC
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 1201 NW 178TH ST STE 119
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City | EDMOND
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State | OK
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Zip | 73012-4280
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Country | US
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Telephone | 405-604-5295
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Fax | 405-604-5297
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Provider Business Mailing Address
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Address Line | 8013 S WESTERN AVE STE A
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-2537
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Country | US
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Telephone | 405-604-5295
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Fax | 405-604-5297
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Authorized Official
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Title or Position | OWNER
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Name | JAMES TYLER PERTREE
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Credential |
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Telephone | 405-604-5295
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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 |
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