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General NPI Number Information
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NPI Number | 1811459191
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Entity Type | Organization
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Legal Business Name | PEAK MOVEMENT CENTRE, PLLC
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Dates
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Enumeration Date | 04/04/2019
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Last Update Date | 04/08/2019
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Provider Practice Location Address
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Address Line | 13816 SANTA FE CROSSING DR
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City | EDMOND
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State | OK
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Zip | 73013
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Country | US
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Telephone | 405-252-0282
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Fax |
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Provider Business Mailing Address
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Address Line | 2424 CROSSING DR
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City | EDMOND
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State | OK
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Zip | 73013-6959
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ANDREW O'BANNON
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Credential | DC
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Telephone | 405-315-7029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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