Provider Demographics
NPI:1376322685
Name:MC CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:MC CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:CHANCE
Authorized Official - Last Name:SHEARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-448-6180
Mailing Address - Street 1:1303 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-1569
Mailing Address - Country:US
Mailing Address - Phone:918-448-6180
Mailing Address - Fax:
Practice Address - Street 1:2115 S HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467
Practice Address - Country:US
Practice Address - Phone:918-448-6180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty