Provider Demographics
NPI:1649649435
Name:MCDONALD CHIROPRACTIC CLINIC L.L.C.
Entity type:Organization
Organization Name:MCDONALD CHIROPRACTIC CLINIC L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-601-8000
Mailing Address - Street 1:2209 W I 240 SERVICE RD STE 312
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-8252
Mailing Address - Country:US
Mailing Address - Phone:405-601-8000
Mailing Address - Fax:405-601-9047
Practice Address - Street 1:2209 W I 240 SERVICE RD STE 312
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-8252
Practice Address - Country:US
Practice Address - Phone:405-601-8000
Practice Address - Fax:405-601-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK445607OtherPTAN