Provider Demographics
NPI:1568836914
Name:JOHN TERRY GODFREY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:JOHN TERRY GODFREY CHIROPRACTIC PLLC
Other - Org Name:GODFREY CHIROPRACTIC CLINIC PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-341-0101
Mailing Address - Street 1:822 W EDMOND RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-5670
Mailing Address - Country:US
Mailing Address - Phone:405-341-0101
Mailing Address - Fax:405-341-9040
Practice Address - Street 1:822 W EDMOND RD
Practice Address - Street 2:SUITE G
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-5670
Practice Address - Country:US
Practice Address - Phone:405-341-0101
Practice Address - Fax:405-341-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty