MEDICARE: JANUARY CHIROPRACTIC & ACUPUNCTURE 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	3996	OK

General Provider Information

NPI Number	:	1427366913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANUARY CHIROPRACTIC & ACUPUNCTURE PLLC

Provider Business Mailing Address
First Line	:	15007 BRISTOL PARK BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73013
Country	:	US
Telephone Number	:	405-749-8000
Fax Number	:	405-749-8007

Provider Business Practice Location Address
First Line	:	15007 BRISTOL PARK BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73013
Country	:	US
Telephone Number	:	405-749-8000
Fax Number	:	405-749-8007

Authorized Official
Title or Position	:	OWNER
Name	:	BRANDON JANUARY
Credential	:	DC
Telephone Number	:	405-749-8000

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	09/17/2010

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