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General NPI Number Information
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NPI Number | 1982888327
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Entity Type | Organization
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Legal Business Name | ELLISON CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 918 NW 32ND ST.
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City | NEWCASTLE
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State | OK
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Zip | 73065-1077
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Country | US
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Telephone | 405-387-4011
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Fax | 405-387-4041
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Provider Business Mailing Address
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Address Line | PO BOX 1077
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City | NEWCASTLE
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State | OK
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Zip | 73065-1077
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Country | US
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Telephone | 405-387-4011
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Fax | 405-387-4041
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Authorized Official
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Title or Position | OWNER
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Name | DR. KYLE JOHN ELLISON
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Credential | D.C.
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Telephone | 405-387-4011
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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 | 3854
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License Number State | OK
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