Provider Demographics
NPI:1417188301
Name:ACTIVE BODY CHIROPRACTIC & REHABILITATION, PLLC
Entity Type:Organization
Organization Name:ACTIVE BODY CHIROPRACTIC & REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-296-0525
Mailing Address - Street 1:9428 S ELWOOD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2317
Mailing Address - Country:US
Mailing Address - Phone:918-296-0525
Mailing Address - Fax:918-296-0526
Practice Address - Street 1:9428 S ELWOOD AVE STE 102
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2317
Practice Address - Country:US
Practice Address - Phone:918-296-0525
Practice Address - Fax:918-296-0526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243509000Medicare PIN