Provider Demographics
NPI:1457038598
Name:PMO YUKON, PLLC
Entity Type:Organization
Organization Name:PMO YUKON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-726-2727
Mailing Address - Street 1:800 W 18TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3759
Mailing Address - Country:US
Mailing Address - Phone:405-923-8897
Mailing Address - Fax:405-216-5724
Practice Address - Street 1:815 E MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2171
Practice Address - Country:US
Practice Address - Phone:405-923-8897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty