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General NPI Number Information
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NPI Number | 1649830183
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Entity Type | Organization
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Legal Business Name | ALVA CHIROPRACTIC CLINIC, P.L.L.C.
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 1716 COLLEGE BLVD
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City | ALVA
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State | OK
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Zip | 73717-3414
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Country | US
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Telephone | 580-327-2468
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Fax | 580-327-3403
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Provider Business Mailing Address
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Address Line | 1716 COLLEGE BLVD
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City | ALVA
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State | OK
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Zip | 73717-3414
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Country | US
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Telephone | 580-327-2468
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Fax | 580-327-3403
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DAWN BLACKLEDGE
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Credential |
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Telephone | 580-327-2468
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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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