Provider Demographics
NPI:1821266842
Name:COVENANT CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:COVENANT CHIROPRACTIC CLINIC PC
Other - Org Name:DR REBEKAH S NUNN
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:NUNN
Authorized Official - Suffix:
Authorized Official - Credentials:BS DC
Authorized Official - Phone:918-307-0077
Mailing Address - Street 1:5153 E 51ST ST
Mailing Address - Street 2:STE 103
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-7456
Mailing Address - Country:US
Mailing Address - Phone:918-307-0077
Mailing Address - Fax:918-508-7445
Practice Address - Street 1:5153 E 51ST ST
Practice Address - Street 2:STE 103
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7456
Practice Address - Country:US
Practice Address - Phone:918-307-0077
Practice Address - Fax:918-508-7445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT CHIROPRACTOC CLINIC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-12
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK300522165Medicaid
OK300522165Medicaid