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General NPI Number Information
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NPI Number | 1528289329
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Entity Type | Organization
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Legal Business Name | ARDMORE CHIROPRACTIC CLINIC, INC.
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 1702 N COMMERCE ST SUITE E
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City | ARDMORE
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State | OK
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Zip | 73401-1525
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Country | US
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Telephone | 580-223-8200
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Fax | 580-223-8212
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Provider Business Mailing Address
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Address Line | 1702 N COMMERCE ST SUITE E
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City | ARDMORE
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State | OK
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Zip | 73401-1525
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Country | US
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Telephone | 580-223-8200
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Fax | 580-223-8212
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Authorized Official
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Title or Position | OWNER
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Name | DR. VANCE A LONG
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Credential | D.C.
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Telephone | 580-223-8200
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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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