Provider Demographics
NPI:1235339763
Name:EXPRESS REHAB
Entity Type:Organization
Organization Name:EXPRESS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-364-0740
Mailing Address - Street 1:5115 N DYSART RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-3036
Mailing Address - Country:US
Mailing Address - Phone:480-503-2400
Mailing Address - Fax:480-539-4685
Practice Address - Street 1:613 24TH AVE SW STE 200
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3984
Practice Address - Country:US
Practice Address - Phone:405-364-0740
Practice Address - Fax:405-364-0752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty