Provider Demographics
NPI:1104016120
Name:CHIROPRACTIC AND ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:CHIROPRACTIC AND ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:TARON
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:580-584-5795
Mailing Address - Street 1:RR 4 BOX 5
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-9400
Mailing Address - Country:US
Mailing Address - Phone:580-584-5795
Mailing Address - Fax:580-584-5796
Practice Address - Street 1:RR 4 BOX 5
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-9400
Practice Address - Country:US
Practice Address - Phone:580-584-5795
Practice Address - Fax:580-584-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU17675Medicare UPIN