Provider Demographics
NPI:1417229451
Name:THIRDROWE, INC.
Entity Type:Organization
Organization Name:THIRDROWE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMATHA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-749-2225
Mailing Address - Street 1:9616 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2714
Mailing Address - Country:US
Mailing Address - Phone:405-749-2225
Mailing Address - Fax:
Practice Address - Street 1:9616 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2714
Practice Address - Country:US
Practice Address - Phone:405-749-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU65942Medicare UPIN