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General NPI Number Information
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NPI Number | 1457038598
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Entity Type | Organization
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Legal Business Name | PMO YUKON, PLLC
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Dates
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Enumeration Date | 06/30/2023
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 815 E MAIN ST STE 120
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City | YUKON
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State | OK
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Zip | 73099-2171
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Country | US
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Telephone | 405-923-8897
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Fax |
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Provider Business Mailing Address
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Address Line | 800 W 18TH ST STE 120
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City | EDMOND
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State | OK
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Zip | 73013-3759
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Country | US
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Telephone | 405-923-8897
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Fax | 405-216-5724
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | BRANT KOENIG
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Credential | DC
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Telephone | 405-726-2727
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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 |
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License Number State |
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