Provider Demographics
NPI:1467880856
Name:STATES CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:STATES CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STATES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-275-1948
Mailing Address - Street 1:2806 N KICKAPOO AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1798
Mailing Address - Country:US
Mailing Address - Phone:405-275-1948
Mailing Address - Fax:405-275-1958
Practice Address - Street 1:2806 N KICKAPOO AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1798
Practice Address - Country:US
Practice Address - Phone:405-275-1948
Practice Address - Fax:405-275-1958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty