Provider Demographics
NPI:1659597417
Name:KIRK CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:KIRK CHIROPRACTIC, P.C.
Other - Org Name:KIRK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:MADENE
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-272-6200
Mailing Address - Street 1:12302 E 86TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2543
Mailing Address - Country:US
Mailing Address - Phone:918-272-6200
Mailing Address - Fax:918-274-3724
Practice Address - Street 1:12302 E 86TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2543
Practice Address - Country:US
Practice Address - Phone:918-272-6200
Practice Address - Fax:918-274-3724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK612649700OtherUS DEPT OF LABOR
OK612649700OtherUS DEPT OF LABOR
OKU68113Medicare UPIN