Provider Demographics
NPI:1033105861
Name:SHEARWOOD CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:SHEARWOOD CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:SHEARWOOD
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:918-485-3785
Mailing Address - Street 1:909 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-2341
Mailing Address - Country:US
Mailing Address - Phone:918-967-3900
Mailing Address - Fax:918-967-3908
Practice Address - Street 1:909 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2341
Practice Address - Country:US
Practice Address - Phone:918-967-3900
Practice Address - Fax:918-967-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK027600002001OtherBLUE CROSS BLUE SHIELD
OK027600002001OtherBLUE CROSS BLUE SHIELD
OK800522054Medicare PIN