Provider Demographics
NPI:1073765293
Name:JAMES W. HINES, D.C., P.C.
Entity Type:Organization
Organization Name:JAMES W. HINES, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-682-8282
Mailing Address - Street 1:25 W OKMULGEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-7847
Mailing Address - Country:US
Mailing Address - Phone:918-682-8282
Mailing Address - Fax:918-686-8522
Practice Address - Street 1:114 N MORTON AVE
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-7317
Practice Address - Country:US
Practice Address - Phone:918-756-6606
Practice Address - Fax:918-756-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK3845111N00000X
OKOK2620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU27393Medicare UPIN