Provider Demographics
NPI:1023219946
Name:ALLSUP CHIROPRACTIC CLINIC INC.
Entity Type:Organization
Organization Name:ALLSUP CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLSUP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-787-2112
Mailing Address - Street 1:1103 E 13TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-7935
Mailing Address - Country:US
Mailing Address - Phone:918-787-6116
Mailing Address - Fax:918-787-6996
Practice Address - Street 1:1103 E 13TH ST STE E
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-7935
Practice Address - Country:US
Practice Address - Phone:918-787-6116
Practice Address - Fax:918-787-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK700522073Medicare ID - Type Unspecified