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General NPI Number Information
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NPI Number | 1174014609
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Entity Type | Organization
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Legal Business Name | SOUL PURPOSE DBA LONE GROVE CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 16982 HIGHWAY 70
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City | LONE GROVE
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State | OK
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Zip | 73443
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Country | US
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Telephone | 580-657-6664
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Fax | 580-657-6663
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Provider Business Mailing Address
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Address Line | PO BOX 147
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City | LONE GROVE
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State | OK
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Zip | 73443-0147
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Country | US
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Telephone | 580-657-6664
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Fax | 580-657-6663
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Authorized Official
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Title or Position | OWNER
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Name | MS. JENNIFER LYNN GALLES
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Credential | D.C.
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Telephone | 580-657-6664
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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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