Provider Demographics
NPI:1831465194
Name:DEREK MAKESCRY LLC
Entity Type:Organization
Organization Name:DEREK MAKESCRY LLC
Other - Org Name:CLINTON CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKESCRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-323-4250
Mailing Address - Street 1:119 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3309
Mailing Address - Country:US
Mailing Address - Phone:580-323-4250
Mailing Address - Fax:580-323-4251
Practice Address - Street 1:119 N 9TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3309
Practice Address - Country:US
Practice Address - Phone:580-323-4250
Practice Address - Fax:580-323-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4066261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center