Provider Demographics
NPI:1225154396
Name:CHIROPRACTIC SERVICES, INC
Entity Type:Organization
Organization Name:CHIROPRACTIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-223-4858
Mailing Address - Street 1:2400 N COMMERCE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1438
Mailing Address - Country:US
Mailing Address - Phone:580-223-4858
Mailing Address - Fax:580-226-6111
Practice Address - Street 1:2400 N COMMERCE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1438
Practice Address - Country:US
Practice Address - Phone:580-223-4858
Practice Address - Fax:580-226-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1596302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK526611643002OtherBLUE CROSS BLUE SHIELD
OKPENDINGOtherMEDICARE ID
OK9204749OtherCIGNA
OK100713340BMedicaid
OK1689644544OtherDC NPI NUMBER
OK526611643002OtherBLUE CROSS BLUE SHIELD