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General NPI Number Information
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NPI Number | 1194924571
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Entity Type | Organization
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Legal Business Name | ADVANCED CHIROPRACTIC CENTER PC
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 206 S MAIN SUITE B
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City | STILLWATER
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State | OK
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Zip | 74074
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Country | US
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Telephone | 405-743-4340
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Fax | 405-372-7000
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Provider Business Mailing Address
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Address Line | 206 S MAIN SUITE B
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City | STILLWATER
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State | OK
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Zip | 74074
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Country | US
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Telephone | 405-743-4340
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Fax | 405-372-7000
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Authorized Official
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Title or Position | DOCTOR
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Name | MR. MONTE TODD CAMPBELL
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Credential | DC
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Telephone | 405-743-4340
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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 | 3262
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License Number State | OK
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