Provider Demographics
NPI:1801024914
Name:BACK & NECK CLINIC, PC
Entity Type:Organization
Organization Name:BACK & NECK CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHAI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-224-0546
Mailing Address - Street 1:1036 E TAFT ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-5731
Mailing Address - Country:US
Mailing Address - Phone:918-224-0546
Mailing Address - Fax:918-347-5551
Practice Address - Street 1:1036 E TAFT ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-5731
Practice Address - Country:US
Practice Address - Phone:918-224-0546
Practice Address - Fax:918-347-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty