MEDICARE: MOVEMENT LABORATORY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4128	OTHER	OK	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1154997989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOVEMENT LABORATORY

Provider Business Mailing Address
First Line	:	5129 E 30TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-6307
Country	:	US
Telephone Number	:	918-740-4183
Fax Number	:

Provider Business Practice Location Address
First Line	:	9238 S SHERIDAN RD STE C
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-5434
Country	:	US
Telephone Number	:	918-300-4084
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN HORACE KEEFE IV
Credential	:	D.C.
Telephone Number	:	918-300-4084

Provider Enumeration Date	:	06/02/2021
Last Update Date	:	11/10/2021

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Directions to “MOVEMENT LABORATORY ” Practice Location

Language	Start Address	Practice Location

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