Provider Demographics
NPI:1710470059
Name:AWESOME CHIROPRACTIC CARE
Entity Type:Organization
Organization Name:AWESOME CHIROPRACTIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERIDAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-865-8811
Mailing Address - Street 1:150 COONROD AVE
Mailing Address - Street 2:
Mailing Address - City:MANNFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74044-0063
Mailing Address - Country:US
Mailing Address - Phone:918-865-8811
Mailing Address - Fax:
Practice Address - Street 1:150 COONROD AVE
Practice Address - Street 2:
Practice Address - City:MANNFORD
Practice Address - State:OK
Practice Address - Zip Code:74044-0063
Practice Address - Country:US
Practice Address - Phone:918-865-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty