Provider Demographics
NPI:1497070262
Name:EASTLAKE HEALTH CARE, INC.
Entity Type:Organization
Organization Name:EASTLAKE HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GOAT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-692-8400
Mailing Address - Street 1:625 CYPRESS DRIVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-6836
Mailing Address - Country:US
Mailing Address - Phone:405-201-7284
Mailing Address - Fax:
Practice Address - Street 1:1000 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2405
Practice Address - Country:US
Practice Address - Phone:405-692-8400
Practice Address - Fax:405-692-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty