Provider Demographics
NPI:1356749980
Name:INTEGRATIVE CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:INTEGRATIVE CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPREITER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:918-691-5671
Mailing Address - Street 1:25945 S HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-2468
Mailing Address - Country:US
Mailing Address - Phone:918-379-0133
Mailing Address - Fax:918-379-0133
Practice Address - Street 1:25945 S HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019-2468
Practice Address - Country:US
Practice Address - Phone:918-770-5760
Practice Address - Fax:918-379-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-14
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty