Provider Demographics
NPI:1518332170
Name:NEURO DYNAMICS LLC
Entity Type:Organization
Organization Name:NEURO DYNAMICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:LELAND
Authorized Official - Last Name:KROTTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-770-9333
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:LOCKBOX #5120
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-1430
Mailing Address - Country:US
Mailing Address - Phone:918-932-2734
Mailing Address - Fax:918-213-4333
Practice Address - Street 1:22 S LEWIS
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:405-627-9335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier