Provider Demographics
NPI:1487854196
Name:CUNNINGHAM CHIROPRACTIC CLINIC, PC
Entity Type:Organization
Organization Name:CUNNINGHAM CHIROPRACTIC CLINIC, PC
Other - Org Name:CUNNINGHAM CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-214-7246
Mailing Address - Street 1:678 KICKAPOO SPUR ST STE B
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-4851
Mailing Address - Country:US
Mailing Address - Phone:405-214-7246
Mailing Address - Fax:405-214-7240
Practice Address - Street 1:678 KICKAPOO SPUR ST STE B
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-4851
Practice Address - Country:US
Practice Address - Phone:405-214-7246
Practice Address - Fax:405-214-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty