=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528187564
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNGERLAND CHIROPRACTIC CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7718 E 91ST ST SUITE 100
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133-6052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-743-2555
-----------------------------------------------------
Fax | 918-743-2583
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7718 E 91ST ST SUITE 100
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133-6052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-743-2555
-----------------------------------------------------
Fax | 918-743-2583
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | FRANK J UNGERLAND III
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 918-743-2555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------