Provider Demographics
NPI:1558538595
Name:SPROWLS CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:SPROWLS CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPROWLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-238-4888
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-0177
Mailing Address - Country:US
Mailing Address - Phone:405-238-4888
Mailing Address - Fax:405-238-2103
Practice Address - Street 1:104 NORTH INDIAN MERIDIAN ROAD
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-0177
Practice Address - Country:US
Practice Address - Phone:405-238-4888
Practice Address - Fax:405-238-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK400522466OtherMEDICARE GROUP
OK446621854OtherBCBS