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General NPI Number Information
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NPI Number | 1326131004
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Entity Type | Organization
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Legal Business Name | OK CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 2865 E SKELLY DR STE 200
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City | TULSA
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State | OK
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Zip | 74105-6219
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Country | US
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Telephone | 918-266-6000
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Fax | 918-266-6002
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Provider Business Mailing Address
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Address Line | PO BOX 172 2400 N. HWY 66, STE E
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City | CATOOSA
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State | OK
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Zip | 74015
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Country | US
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Telephone | 918-266-6000
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Fax | 918-266-6002
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Authorized Official
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Title or Position | OWNER/DC
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Name | LANCE GOODWIN
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Credential | D.C.
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Telephone | 918-266-6000
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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 | 3564
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3511
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License Number State | OK
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