Provider Demographics
NPI:1619018413
Name:CHIROPRACTIC CENTER OF OKLAHOMA INC
Entity Type:Organization
Organization Name:CHIROPRACTIC CENTER OF OKLAHOMA INC
Other - Org Name:PIEDMONT CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:DIAN
Authorized Official - Last Name:STATES
Authorized Official - Suffix:I
Authorized Official - Credentials:DC
Authorized Official - Phone:405-373-4554
Mailing Address - Street 1:51 GOODER SIMPSON BLVD. NE
Mailing Address - Street 2:STE B
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078
Mailing Address - Country:US
Mailing Address - Phone:405-373-4554
Mailing Address - Fax:405-373-3966
Practice Address - Street 1:51 GOODER SIMPSON BLVD. NE
Practice Address - Street 2:STE B
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078
Practice Address - Country:US
Practice Address - Phone:405-373-4554
Practice Address - Fax:405-373-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3045261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service