Provider Demographics
NPI:1124472907
Name:ELLIOTT CENTER OF CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:ELLIOTT CENTER OF CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-252-9915
Mailing Address - Street 1:7110 S. MINGO RD.
Mailing Address - Street 2:STE 107
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3273
Mailing Address - Country:US
Mailing Address - Phone:918-252-9915
Mailing Address - Fax:918-252-9102
Practice Address - Street 1:7110 S. MINGO RD
Practice Address - Street 2:STE 107
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3273
Practice Address - Country:US
Practice Address - Phone:918-252-9915
Practice Address - Fax:918-252-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty