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NPI Code Detail

MEDICARE: CENTRAL OKLAHOMA CHIROPRACTIC CLINIC INC

MEDICARE: CENTRAL OKLAHOMA CHIROPRACTIC CLINIC INC
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
1111N00000XChiropractor3465OK

General Provider Information

NPI Number : 1174714877
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL OKLAHOMA CHIROPRACTIC CLINIC INC
Provider Business Mailing Address
First Line : 602 N BROADWAY ST
Second Line : PO BOX 589
City : TECUMSEH
State : OK
Zip : 74873-2020
Country : US
Telephone Number : 405-598-6768
Fax Number : 405-597-6770
Provider Business Practice Location Address
First Line : 602 N BROADWAY ST
Second Line :
City : TECUMSEH
State : OK
Zip : 74873-2020
Country : US
Telephone Number : 405-598-6768
Fax Number : 405-597-6770
Authorized Official
Title or Position : PRESIDENT
Name : DR. JUSTIN RAY PHILLIPS
Credential : DC
Telephone Number : 405-598-6768
Provider Enumeration Date : 08/07/2007
Last Update Date : 07/24/2012

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Directions to “CENTRAL OKLAHOMA CHIROPRACTIC CLINIC INC ” Practice Location

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