Provider Demographics
NPI:1518009216
Name:ADVANCED CHIRORPACTIC CARE PLLC
Entity Type:Organization
Organization Name:ADVANCED CHIRORPACTIC CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMEBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEBOER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-664-3535
Mailing Address - Street 1:PO BOX 521125
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74152-1125
Mailing Address - Country:US
Mailing Address - Phone:918-664-3535
Mailing Address - Fax:918-664-4323
Practice Address - Street 1:1322 E 15TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-5804
Practice Address - Country:US
Practice Address - Phone:918-664-3535
Practice Address - Fax:918-664-4323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty