Provider Demographics
NPI:1225354541
Name:ASHLOCK CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ASHLOCK CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ASHLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-272-0444
Mailing Address - Street 1:12899 E 76TH ST N STE 101
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4059
Mailing Address - Country:US
Mailing Address - Phone:918-272-0444
Mailing Address - Fax:918-272-0447
Practice Address - Street 1:12899 E 76TH ST N STE 101
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4059
Practice Address - Country:US
Practice Address - Phone:918-272-0444
Practice Address - Fax:918-272-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3807111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK232721302Medicare PIN