Provider Demographics
NPI:1003133075
Name:PACK, MAGGIE A (DC)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:A
Last Name:PACK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:A
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:26251 HIGHWAY 82
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PARK HILL
Mailing Address - State:OK
Mailing Address - Zip Code:74451-3802
Mailing Address - Country:US
Mailing Address - Phone:918-456-6400
Mailing Address - Fax:
Practice Address - Street 1:26251 HIGHWAY 82
Practice Address - Street 2:SUITE 2
Practice Address - City:PARK HILL
Practice Address - State:OK
Practice Address - Zip Code:74451-3802
Practice Address - Country:US
Practice Address - Phone:918-456-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor