Provider Demographics
NPI:1710285523
Name:TALLANT CHIROPRACTIC
Entity Type:Organization
Organization Name:TALLANT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:TALLANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-245-2790
Mailing Address - Street 1:3949 S HIGHWAY 97
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-3829
Mailing Address - Country:US
Mailing Address - Phone:918-245-2790
Mailing Address - Fax:918-245-8436
Practice Address - Street 1:3949 S HIGHWAY 97
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-3829
Practice Address - Country:US
Practice Address - Phone:918-245-2790
Practice Address - Fax:918-245-8436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty