Provider Demographics
NPI:1497253009
Name:EPIC CONNECTION CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:EPIC CONNECTION CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MALAKI
Authorized Official - Middle Name:WALKER
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-728-9301
Mailing Address - Street 1:1344 E HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2389
Mailing Address - Country:US
Mailing Address - Phone:918-921-4247
Mailing Address - Fax:
Practice Address - Street 1:1344 E HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2389
Practice Address - Country:US
Practice Address - Phone:918-921-4247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty