Provider Demographics
NPI:1093956468
Name:JOLLEY CHIROPRACTIC AND WELLNESS PRACTICE, PLLC.
Entity Type:Organization
Organization Name:JOLLEY CHIROPRACTIC AND WELLNESS PRACTICE, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LUKE
Authorized Official - Last Name:JOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-394-9400
Mailing Address - Street 1:12345 S MEMORIAL DR STE 111
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2570
Mailing Address - Country:US
Mailing Address - Phone:918-394-9400
Mailing Address - Fax:
Practice Address - Street 1:12345 S MEMORIAL DR STE 111
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2570
Practice Address - Country:US
Practice Address - Phone:918-394-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5539Medicare PIN