=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881819803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLE CHIROPRACTIC CLINIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2007
-----------------------------------------------------
Last Update Date | 11/14/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5424 S MEMORIAL DR SUITE B-2
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74145-9003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-664-2273
-----------------------------------------------------
Fax | 918-664-2204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5424 S MEMORIAL DR SUITE B-2
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74145-9003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-664-2273
-----------------------------------------------------
Fax | 918-664-2204
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHRISTOPHER KEVIN COLE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 918-664-2273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NN1001X
-----------------------------------------------------
Taxonomy Name | Nutrition Chiropractor
-----------------------------------------------------
License Number | 3202
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3202
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------