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General NPI Number Information
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NPI Number | 1962772855
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Entity Type | Organization
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Legal Business Name | FOUTZ CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 01/09/2012
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 997 W WILL ROGERS BLVD SUITE A
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City | CLAREMORE
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State | OK
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Zip | 74017-5416
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Country | US
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Telephone | 918-283-2222
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Fax | 918-341-6976
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Provider Business Mailing Address
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Address Line | 997 W WILL ROGERS BLVD SUITE A
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City | CLAREMORE
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State | OK
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Zip | 74017-5416
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Country | US
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Telephone | 918-283-2222
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Fax | 918-341-6976
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | TINA FOUTZ
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Credential | D.C.
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Telephone | 918-283-2222
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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 | 3450
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License Number State | OK
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