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General NPI Number Information
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NPI Number | 1164615407
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Entity Type | Organization
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Legal Business Name | PEACE CHIROPRACTIC CLINIC, P.C.
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 4134 S HARVARD AVE STE B2
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City | TULSA
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State | OK
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Zip | 74135-2628
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Country | US
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Telephone | 917-747-2717
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Fax | 918-747-2718
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Provider Business Mailing Address
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Address Line | 4134 S HARVARD AVE STE B2
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City | TULSA
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State | OK
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Zip | 74135-2613
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Country | US
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Telephone | 917-747-2717
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Fax | 918-747-2718
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. ROBERT P PEACE
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Credential | D.C.
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Telephone | 918-747-2717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 3461
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License Number State | OK
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