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General NPI Number Information
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NPI Number | 1447640479
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Entity Type | Organization
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Legal Business Name | MTP CHIROPRACTIC LLC
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Dates
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Enumeration Date | 01/29/2015
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 1991 TOWER DR SUITE G
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City | MOORE
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State | OK
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Zip | 73160-2388
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Country | US
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Telephone | 405-735-8282
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Fax | 405-735-8262
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Provider Business Mailing Address
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Address Line | 1991 TOWER DR SUITE G
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City | MOORE
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State | OK
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Zip | 73160-2388
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Country | US
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Telephone | 405-735-8282
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Fax | 405-735-8262
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. MOLLIE PERTREE
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Credential | DC
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Telephone | 405-735-8282
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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 | 3775
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License Number State | OK
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