Provider Demographics
NPI:1407197866
Name:FRONTIER FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:FRONTIER FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-557-6299
Mailing Address - Street 1:1132 PROVIDENCE CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-6155
Mailing Address - Country:US
Mailing Address - Phone:918-557-6299
Mailing Address - Fax:
Practice Address - Street 1:1132 PROVIDENCE CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-6155
Practice Address - Country:US
Practice Address - Phone:918-557-6299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty