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General NPI Number Information
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NPI Number | 1891688925
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Entity Type | Organization
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Legal Business Name | ELEVATED CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 3882 W 530 STE D
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City | PRYOR
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State | OK
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Zip | 74361-8092
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Country | US
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Telephone | 913-303-9680
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Fax |
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Provider Business Mailing Address
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Address Line | 3044 W 410 RD
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City | ADAIR
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State | OK
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Zip | 74330-2824
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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 | OWNER
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Name | BAILEY FORELL
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Credential | DC
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Telephone | 785-656-0234
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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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