Provider Demographics
NPI:1073751251
Name:JOHNSON STRAIGHT CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:JOHNSON STRAIGHT CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-747-5100
Mailing Address - Street 1:2140 S HARVARD AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1960
Mailing Address - Country:US
Mailing Address - Phone:918-747-5100
Mailing Address - Fax:918-747-5134
Practice Address - Street 1:2140 S HARVARD AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1960
Practice Address - Country:US
Practice Address - Phone:918-747-5100
Practice Address - Fax:918-747-5134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5415Medicare PIN