Provider Demographics
NPI:1801825732
Name:ALTERNATIVE CARE CLINIC, INC.
Entity Type:Organization
Organization Name:ALTERNATIVE CARE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLIPPERTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-238-7502
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-0056
Mailing Address - Country:US
Mailing Address - Phone:405-238-7502
Mailing Address - Fax:405-238-5269
Practice Address - Street 1:400 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-3811
Practice Address - Country:US
Practice Address - Phone:405-238-7502
Practice Address - Fax:405-238-5269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100831410AMedicaid
OK100831410AMedicaid
OKQDCGMMedicare ID - Type Unspecified