Provider Demographics
NPI:1336193796
Name:CARVER CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:CARVER CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GWIN
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-285-2244
Mailing Address - Street 1:2805 S BRYANT AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6158
Mailing Address - Country:US
Mailing Address - Phone:405-285-2244
Mailing Address - Fax:405-285-0004
Practice Address - Street 1:2805 S BRYANT AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6158
Practice Address - Country:US
Practice Address - Phone:405-285-2244
Practice Address - Fax:405-285-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK446727707003OtherBLUE CROSS / BLUE SHIELD
OK446727707003OtherBLUE CROSS / BLUE SHIELD