Provider Demographics
NPI:1245456656
Name:EDMOND FAMILY CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:EDMOND FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILLSPAUGH
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:405-359-1880
Mailing Address - Street 1:412 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-6336
Mailing Address - Country:US
Mailing Address - Phone:405-359-1880
Mailing Address - Fax:405-359-1877
Practice Address - Street 1:412 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-6336
Practice Address - Country:US
Practice Address - Phone:405-359-1880
Practice Address - Fax:405-359-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK800522194Medicare ID - Type UnspecifiedPROVIDER ID