MEDICARE: PMO DEER CREEK, PLLC

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

General Provider Information

NPI Number	:	1184574717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PMO DEER CREEK, PLLC

Provider Business Mailing Address
First Line	:	4608 FRISCO BRIDGE BLVD
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-7170
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 W 18TH ST STE 120
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-3759
Country	:	US
Telephone Number	:	405-726-2727
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN
Name	:	BRANT KOENIG
Credential	:	DC
Telephone Number	:	405-210-2202

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “PMO DEER CREEK, PLLC ” Practice Location

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