=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275858474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOTION IS LIFE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2010
-----------------------------------------------------
Last Update Date | 10/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 24TH AVE NW SUITE# 114
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-6498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-329-2000
-----------------------------------------------------
Fax | 405-329-2000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 24TH AVE NW SUITE# 114
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-6498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-329-2000
-----------------------------------------------------
Fax | 405-329-2058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER OF MOTION IS LIFE, LLC
-----------------------------------------------------
Name | DR. KREG GRIFFITH
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 405-408-2669
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3646
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3946
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------