MEDICARE: CHIROPRACTIC ASSOCIATES 300, 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
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1962145441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC ASSOCIATES 300, LLC

Provider Business Mailing Address
First Line	:	300 N 5TH ST
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-4512
Country	:	US
Telephone Number	:	580-762-1291
Fax Number	:	580-762-1379

Provider Business Practice Location Address
First Line	:	300 N 5TH ST
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-4512
Country	:	US
Telephone Number	:	580-762-1291
Fax Number	:	580-762-1379

Authorized Official
Title or Position	:	LLC MEMBER
Name	:	DR. SCOTT THOMAS KIRKPATRICK
Credential	:	D.C.
Telephone Number	:	918-808-7725

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	04/14/2022

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