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General NPI Number Information
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NPI Number | 1851685416
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Entity Type | Organization
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Legal Business Name | KEYS CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 26251 HIGHWAY 82
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City | PARK HILL
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State | OK
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Zip | 74451-3802
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Country | US
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Telephone | 918-510-9850
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 E VANCOUVER ST
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City | BROKEN ARROW
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State | OK
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Zip | 74014-4629
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Country | US
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Telephone | 918-510-9850
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. ELAINE LAVERNE CLINTON
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Credential | D.C.
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Telephone | 918-510-9850
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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 | 3968
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License Number State | OK
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