Provider Demographics
NPI:1548591035
Name:GREEN FAMILY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:GREEN FAMILY CHIROPRACTIC, INC.
Other - Org Name:LIVE WELL MUSTANG CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-376-4300
Mailing Address - Street 1:500 N FINANCIAL TER
Mailing Address - Street 2:STE G
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4437
Mailing Address - Country:US
Mailing Address - Phone:405-376-4300
Mailing Address - Fax:405-376-4307
Practice Address - Street 1:500 N FINANCIAL TER
Practice Address - Street 2:STE G
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4437
Practice Address - Country:US
Practice Address - Phone:405-376-4300
Practice Address - Fax:405-376-4307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty