=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275726465
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRAY ENTERPRISES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2007
-----------------------------------------------------
Last Update Date | 01/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 SOUTH COLUMBIA AVE SUITE 104
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-712-2220
-----------------------------------------------------
Fax | 918-712-7379
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2121 SOUTH COLUMBIA AVE SUITE 104
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-712-2220
-----------------------------------------------------
Fax | 918-712-7379
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | DR. DOUG L PRAY
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 918-712-7379
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3345
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------