Provider Demographics
NPI:1073781795
Name:PEERY CHIROPRACTIC CLINIC, PLLC
Entity Type:Organization
Organization Name:PEERY CHIROPRACTIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:PEERY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-254-7779
Mailing Address - Street 1:6117 S MINGO RD
Mailing Address - Street 2:STE-C
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6315
Mailing Address - Country:US
Mailing Address - Phone:918-254-7779
Mailing Address - Fax:918-254-7227
Practice Address - Street 1:6117 S MINGO RD
Practice Address - Street 2:STE-C
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6315
Practice Address - Country:US
Practice Address - Phone:918-254-7779
Practice Address - Fax:918-254-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty