Provider Demographics
NPI:1073762381
Name:OKINAKUL INC.
Entity Type:Organization
Organization Name:OKINAKUL INC.
Other - Org Name:PROACTIVE CHIROPRACTIC AND REHABILITATION CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:ULSRUD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-891-0035
Mailing Address - Street 1:11661 PRESTON RD STE 129
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6192
Mailing Address - Country:US
Mailing Address - Phone:214-891-0035
Mailing Address - Fax:214-891-0033
Practice Address - Street 1:11661 PRESTON RD STE 129
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6192
Practice Address - Country:US
Practice Address - Phone:214-891-0035
Practice Address - Fax:214-891-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty