Provider Demographics
NPI:1891492476
Name:918 CHIROPRACTIC OWASSO
Entity Type:Organization
Organization Name:918 CHIROPRACTIC OWASSO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GRISWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-212-8688
Mailing Address - Street 1:12150 E 96TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-5340
Mailing Address - Country:US
Mailing Address - Phone:918-212-8688
Mailing Address - Fax:866-352-5122
Practice Address - Street 1:12150 E 96TH ST N STE 200
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-5340
Practice Address - Country:US
Practice Address - Phone:918-212-8688
Practice Address - Fax:866-352-5122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty