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General NPI Number Information
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NPI Number | 1376046433
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Entity Type | Organization
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Legal Business Name | SPINE SPA PLLC
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Dates
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Enumeration Date | 03/15/2018
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Last Update Date | 03/15/2018
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Provider Practice Location Address
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Address Line | 7302 S YALE AVE
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City | TULSA
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State | OK
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Zip | 74136-7027
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Country | US
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Telephone | 918-671-8805
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Fax |
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Provider Business Mailing Address
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Address Line | 7302 S YALE AVE
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City | TULSA
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State | OK
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Zip | 74136-7027
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Country | US
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Telephone | 918-671-8805
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. JOHN ARMSTRONG OWENS
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Credential | DC
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Telephone | 918-671-8805
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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 | 4231
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License Number State | OK
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