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General NPI Number Information
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NPI Number | 1962808600
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Entity Type | Organization
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Legal Business Name | DR. KRISTA SCHUCK CHIROPRACTIC
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Dates
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Enumeration Date | 11/07/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 134 E 15TH ST
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City | EDMOND
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State | OK
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Zip | 73013-4303
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Country | US
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Telephone | 405-492-1000
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Fax | 405-330-6616
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Provider Business Mailing Address
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Address Line | 134 E 15TH ST
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City | EDMOND
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State | OK
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Zip | 73013-4303
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Country | US
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Telephone | 405-492-1000
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Fax | 405-330-6616
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | KRISTA SCHUCK
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Credential | DC
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Telephone | 405-492-1000
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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 | 4181
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License Number State | OK
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