Provider Demographics
NPI:1477183416
Name:CAC OF YUKON
Entity Type:Organization
Organization Name:CAC OF YUKON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:WHITTEN
Authorized Official - Last Name:MUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-794-5000
Mailing Address - Street 1:804 NE 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-8976
Mailing Address - Country:US
Mailing Address - Phone:405-794-5000
Mailing Address - Fax:405-794-5003
Practice Address - Street 1:804 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-8976
Practice Address - Country:US
Practice Address - Phone:405-794-5000
Practice Address - Fax:405-794-5003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KYLE W MUSE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty