Provider Demographics
NPI:1366503294
Name:LJG INC
Entity Type:Organization
Organization Name:LJG INC
Other - Org Name:CHIROPRACTIC PHYSICIANS CLINIC GEORGE F GORTON DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT LJG INC
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:GORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-542-6853
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:200 N NOBLE
Mailing Address - City:HINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73047-0238
Mailing Address - Country:US
Mailing Address - Phone:405-542-6853
Mailing Address - Fax:405-542-3339
Practice Address - Street 1:200 N NOBLE
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:OK
Practice Address - Zip Code:73047-0238
Practice Address - Country:US
Practice Address - Phone:405-542-6853
Practice Address - Fax:405-542-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK441421822002OtherBLUE CROSS BLUE SHIELD
OKT87029Medicare ID - Type Unspecified