Provider Demographics
NPI:1275788697
Name:ULTIMATE FIT CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:ULTIMATE FIT CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROGGENBUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-248-8322
Mailing Address - Street 1:1108 SW B AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4229
Mailing Address - Country:US
Mailing Address - Phone:580-248-8322
Mailing Address - Fax:580-248-8323
Practice Address - Street 1:1108 SW B AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4229
Practice Address - Country:US
Practice Address - Phone:580-248-8322
Practice Address - Fax:580-248-8323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty