MEDICARE: NORTH OKC CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4237	OK

General Provider Information

NPI Number	:	1043761422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH OKC CHIROPRACTIC

Provider Business Mailing Address
First Line	:	5109 N SHARTEL AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-6024
Country	:	US
Telephone Number	:	405-810-5501
Fax Number	:	888-481-4758

Provider Business Practice Location Address
First Line	:	5109 N SHARTEL AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-6024
Country	:	US
Telephone Number	:	405-810-5501
Fax Number	:	888-481-4758

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JUSTIN ATKINSON
Credential	:	D.C
Telephone Number	:	405-810-5501

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	10/20/2016

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