Provider Demographics
NPI:1609193317
Name:CHI-MED LEASING, INC.
Entity Type:Organization
Organization Name:CHI-MED LEASING, INC.
Other - Org Name:NECK & BACK PAIN TMT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-786-6500
Mailing Address - Street 1:27910 S 563 RD
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:OK
Mailing Address - Zip Code:74331-8076
Mailing Address - Country:US
Mailing Address - Phone:918-786-6500
Mailing Address - Fax:918-786-6500
Practice Address - Street 1:204A S GRAND ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-3225
Practice Address - Country:US
Practice Address - Phone:918-786-6500
Practice Address - Fax:918-786-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3459111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty