Provider Demographics
NPI:1801014097
Name:POWER CLINIC OF CHIROPRACTIC & ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:POWER CLINIC OF CHIROPRACTIC & ACUPUNCTURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JAYLYNN
Authorized Official - Last Name:HAZDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-332-8200
Mailing Address - Street 1:1180 N HILLS SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-1864
Mailing Address - Country:US
Mailing Address - Phone:580-332-8200
Mailing Address - Fax:
Practice Address - Street 1:1180 N HILLS SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-1864
Practice Address - Country:US
Practice Address - Phone:580-332-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK800522250Medicare ID - Type UnspecifiedCLINIC