Provider Demographics
NPI:1366646051
Name:MABRA FAMILY CHIRORPRACTIC PLLC
Entity Type:Organization
Organization Name:MABRA FAMILY CHIRORPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MABRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-254-5145
Mailing Address - Street 1:911 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-2447
Mailing Address - Country:US
Mailing Address - Phone:580-254-5145
Mailing Address - Fax:580-254-5144
Practice Address - Street 1:911 17TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-2447
Practice Address - Country:US
Practice Address - Phone:580-254-5145
Practice Address - Fax:580-254-5144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1063545770OtherNPI TYPE 1