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General NPI Number Information
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NPI Number | 1508965252
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Entity Type | Organization
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Legal Business Name | TERA EGLESTON CHIROPRACTIC CLINIC PC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9100 N GARNETT RD SUITE I
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City | OWASSO
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State | OK
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Zip | 74055
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Country | US
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Telephone | 918-274-2911
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Fax | 918-274-2911
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Provider Business Mailing Address
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Address Line | PO BOX 1161
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City | OWASSO
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State | OK
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Zip | 74055
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Country | US
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Telephone | 918-274-2911
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Fax | 918-274-2911
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Authorized Official
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Title or Position | DOCTOR OWNER
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Name | TERA MARCHELLE EGLESTON
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Credential | DC
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Telephone | 918-274-2911
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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 | 3469
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License Number State | OK
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