Provider Demographics
NPI:1619468592
Name:BP GROUP PC VERTEBRAE
Entity Type:Organization
Organization Name:BP GROUP PC VERTEBRAE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-770-8984
Mailing Address - Street 1:200 S BLOOMINGTON ST STE I
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-9492
Mailing Address - Country:US
Mailing Address - Phone:479-770-8984
Mailing Address - Fax:479-770-0864
Practice Address - Street 1:1301 S I 35 SERVICE RD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3182
Practice Address - Country:US
Practice Address - Phone:405-759-2255
Practice Address - Fax:405-703-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty