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NPI Code Detail

MEDICARE: PEORIA MEDICAL LLC

MEDICARE: PEORIA MEDICAL LLC
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
1111NR0400XRehabilitation Chiropractor3542OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11992897920OTHEROKNPI

General Provider Information

NPI Number : 1396930277
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEORIA MEDICAL LLC
Provider Business Mailing Address
First Line : 3345 S HARVARD AVE
Second Line : STE #101
City : TULSA
State : OK
Zip : 74135-1812
Country : US
Telephone Number : 918-743-3737
Fax Number : 918-743-8383
Provider Business Practice Location Address
First Line : 3345 S HARVARD AVE
Second Line : STE #101
City : TULSA
State : OK
Zip : 74135-1812
Country : US
Telephone Number : 918-743-3737
Fax Number : 918-743-8383
Authorized Official
Title or Position : OWNER
Name : MR. SEAN RILEY
Credential : D.C.
Telephone Number : 918-743-3737
Provider Enumeration Date : 09/13/2007
Last Update Date : 09/13/2007

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Directions to “PEORIA MEDICAL LLC ” Practice Location

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