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General NPI Number Information
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NPI Number | 1215516166
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Entity Type | Organization
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Legal Business Name | VENUS SPORTS PERFORMANCE AND REHAB LLC
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 812 S WALNUT ST
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City | STILLWATER
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State | OK
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Zip | 74074-4225
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Country | US
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Telephone | 620-660-9777
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Fax |
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Provider Business Mailing Address
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Address Line | 812 S WALNUT ST
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City | STILLWATER
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State | OK
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Zip | 74074-4225
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | SPENCER VENUS
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Credential | D.C.
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Telephone | 620-660-9777
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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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