Provider Demographics
NPI:1003036518
Name:BACK & POSTURE CLINIC OF OKLAHOMA
Entity Type:Organization
Organization Name:BACK & POSTURE CLINIC OF OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:E
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-634-5400
Mailing Address - Street 1:6510 S WESTERN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-1712
Mailing Address - Country:US
Mailing Address - Phone:405-634-5400
Mailing Address - Fax:405-634-5174
Practice Address - Street 1:6510 S WESTERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1712
Practice Address - Country:US
Practice Address - Phone:405-634-5400
Practice Address - Fax:405-634-5174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty