MEDICARE: CHICOINE 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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1427204361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICOINE CHIROPRACTIC CLINIC INC

Provider Business Mailing Address
First Line	:	3739 E 11TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74112-3951
Country	:	US
Telephone Number	:	918-836-2225
Fax Number	:	918-834-3174

Provider Business Practice Location Address
First Line	:	3739 E 11TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74112-3951
Country	:	US
Telephone Number	:	918-836-2225
Fax Number	:	918-834-3174

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GERALD DAVID CHICOINE
Credential	:	D.C.
Telephone Number	:	918-836-2225

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	06/15/2011

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