Provider Demographics
NPI:1972740264
Name:HEALING LIFE CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:HEALING LIFE CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:GULBRANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-500-4452
Mailing Address - Street 1:1335 E 11TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4602
Mailing Address - Country:US
Mailing Address - Phone:918-500-4452
Mailing Address - Fax:
Practice Address - Street 1:1335 E 11TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4602
Practice Address - Country:US
Practice Address - Phone:918-500-4452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3737302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization