Provider Demographics
NPI:1174014609
Name:SOUL PURPOSE DBA LONE GROVE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:SOUL PURPOSE DBA LONE GROVE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GALLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-657-6664
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:LONE GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:73443-0147
Mailing Address - Country:US
Mailing Address - Phone:580-657-6664
Mailing Address - Fax:580-657-6663
Practice Address - Street 1:16982 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:LONE GROVE
Practice Address - State:OK
Practice Address - Zip Code:73443
Practice Address - Country:US
Practice Address - Phone:580-657-6664
Practice Address - Fax:580-657-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty