Provider Demographics
NPI:1134395502
Name:CLARK COUNTY CHIROPRACTIC P.A.
Entity type:Organization
Organization Name:CLARK COUNTY CHIROPRACTIC P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCHUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-602-8925
Mailing Address - Street 1:8924 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9202
Mailing Address - Country:US
Mailing Address - Phone:405-602-8925
Mailing Address - Fax:405-604-3021
Practice Address - Street 1:8924 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9202
Practice Address - Country:US
Practice Address - Phone:405-602-8925
Practice Address - Fax:405-604-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty