Provider Demographics
NPI:1649547001
Name:JAVERSAK FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:JAVERSAK FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JAVERSAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-424-9555
Mailing Address - Street 1:1005 SHADY HOLW
Mailing Address - Street 2:1005 SHADY HOLLOW CT
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-8342
Mailing Address - Country:US
Mailing Address - Phone:918-424-9555
Mailing Address - Fax:918-420-5552
Practice Address - Street 1:1005 SHADY HOLW
Practice Address - Street 2:1005 SHADY HOLLOW CT
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-8342
Practice Address - Country:US
Practice Address - Phone:918-424-9555
Practice Address - Fax:918-420-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3513305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service