Provider Demographics
NPI:1750306445
Name:CULVER CLINIC OF CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:CULVER CLINIC OF CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CULVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-658-6604
Mailing Address - Street 1:412 N BROADWAY ST
Mailing Address - Street 2:P.O. BOX 206
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055-1838
Mailing Address - Country:US
Mailing Address - Phone:580-658-6604
Mailing Address - Fax:580-652-5111
Practice Address - Street 1:412 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MARLOW
Practice Address - State:OK
Practice Address - Zip Code:73055-1838
Practice Address - Country:US
Practice Address - Phone:580-658-6604
Practice Address - Fax:580-652-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKV4463614602Medicaid
OKQDBCPMedicare ID - Type Unspecified
OKV4463614602Medicaid