Provider Demographics
NPI:1114126711
Name:JASON H HALE CHIROPRACTIC P C
Entity Type:Organization
Organization Name:JASON H HALE CHIROPRACTIC P C
Other - Org Name:HALE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-310-9755
Mailing Address - Street 1:428 E 10TH ST
Mailing Address - Street 2:429 E 10TH ST
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-5221
Mailing Address - Country:US
Mailing Address - Phone:580-310-9755
Mailing Address - Fax:
Practice Address - Street 1:428 E 10TH ST
Practice Address - Street 2:429 E. 10TH ST
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5221
Practice Address - Country:US
Practice Address - Phone:580-310-9755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2538261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========001OtherBLUE CROSS BLUE SHIELD
OK=========001OtherBLUE CROSS BLUE SHIELD