Provider Demographics
NPI:1619092483
Name:FAMILY CHIROPRACTIC P C
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC P C
Other - Org Name:ADVANCED RELIEF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBYNN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:POORTVLIET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-822-4476
Mailing Address - Street 1:PO BOX 21824
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-1824
Mailing Address - Country:US
Mailing Address - Phone:405-634-0042
Mailing Address - Fax:405-632-7976
Practice Address - Street 1:8901 S SANTA FE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-8413
Practice Address - Country:US
Practice Address - Phone:405-634-0042
Practice Address - Fax:405-632-7976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK800522216Medicare PIN