=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508152653
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TENSEGRITY CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2011
-----------------------------------------------------
Last Update Date | 06/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6808 S MEMORIAL DR STE 100
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133-2066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-481-0655
-----------------------------------------------------
Fax | 918-481-8729
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6808 S MEMORIAL DR STE 100
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133-2066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-481-0655
-----------------------------------------------------
Fax | 918-481-8729
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CHRISTOPHER R BARNES
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 918-481-0655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4027
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------