Provider Demographics
NPI:1972893402
Name:BACK AND POSTURE CLINIC OF OKLAHOMA, L.L.C.
Entity Type:Organization
Organization Name:BACK AND POSTURE CLINIC OF OKLAHOMA, L.L.C.
Other - Org Name:BACK AND POSTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:S
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:405-634-5400
Mailing Address - Street 1:6510 S WESTERN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-1712
Mailing Address - Country:US
Mailing Address - Phone:405-634-5400
Mailing Address - Fax:405-634-5174
Practice Address - Street 1:6510 S WESTERN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1712
Practice Address - Country:US
Practice Address - Phone:405-634-5400
Practice Address - Fax:405-634-5174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK241406902Medicare PIN
OKD38547Medicare UPIN