Provider Demographics
NPI:1003340365
Name:INSIDE OUT CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:INSIDE OUT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-984-1564
Mailing Address - Street 1:7891 E 108TH ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7405
Mailing Address - Country:US
Mailing Address - Phone:918-984-1564
Mailing Address - Fax:
Practice Address - Street 1:7891 E 108TH ST
Practice Address - Street 2:SUITE 16
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7405
Practice Address - Country:US
Practice Address - Phone:918-984-1564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4246111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty