Provider Demographics
NPI:1689038515
Name:HOLBROOK CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:HOLBROOK CHIROPRACTIC PLLC
Other - Org Name:LIVEWELL FAMILY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-295-2955
Mailing Address - Street 1:1633A E US HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-5769
Mailing Address - Country:US
Mailing Address - Phone:405-295-2955
Mailing Address - Fax:405-295-2966
Practice Address - Street 1:1633A E US HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-5769
Practice Address - Country:US
Practice Address - Phone:405-295-2955
Practice Address - Fax:405-295-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty