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General NPI Number Information
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NPI Number | 1578640975
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Entity Type | Organization
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Legal Business Name | BRANT T KOENIG PLLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 305 N BROADWAY
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City | EDMOND
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State | OK
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Zip | 73034-3681
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Country | US
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Telephone | 405-348-5901
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Fax | 405-348-5923
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Provider Business Mailing Address
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Address Line | 800 W 18TH ST SUITE 120
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City | EDMOND
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State | OK
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Zip | 73013-3758
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Country | US
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Telephone | 405-286-0322
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Fax | 405-285-7034
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRANT THOMAS KOENIG
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Credential | D.C.
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Telephone | 405-348-5901
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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 | 3800
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License Number State | OK
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