Provider Demographics
NPI:1326131004
Name:OK CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:OK CHIROPRACTIC PLLC
Other - Org Name:GOODWIN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DC
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-266-6000
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:2400 N. HWY 66, STE E
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015
Mailing Address - Country:US
Mailing Address - Phone:918-266-6000
Mailing Address - Fax:918-266-6002
Practice Address - Street 1:2865 E SKELLY DR STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6219
Practice Address - Country:US
Practice Address - Phone:918-266-6000
Practice Address - Fax:918-266-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3511111N00000X
OK3564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty