Provider Demographics
NPI:1770802456
Name:TENKILLER FAMILY CHIROPRACITC
Entity type:Organization
Organization Name:TENKILLER FAMILY CHIROPRACITC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PACK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:918-773-3025
Mailing Address - Street 1:512 S. THORNTON STREET
Mailing Address - Street 2:
Mailing Address - City:VIAN
Mailing Address - State:OK
Mailing Address - Zip Code:74962
Mailing Address - Country:US
Mailing Address - Phone:918-773-3025
Mailing Address - Fax:
Practice Address - Street 1:512 S. THORNTON STREET
Practice Address - Street 2:
Practice Address - City:VIAN
Practice Address - State:OK
Practice Address - Zip Code:74962
Practice Address - Country:US
Practice Address - Phone:918-773-3025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3978111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty