Provider Demographics
NPI:1841321908
Name:LAWYER CHIROPRACITC CLINIC
Entity type:Organization
Organization Name:LAWYER CHIROPRACITC CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-299-1296
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-0480
Mailing Address - Country:US
Mailing Address - Phone:918-299-1296
Mailing Address - Fax:918-299-1534
Practice Address - Street 1:609 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-4138
Practice Address - Country:US
Practice Address - Phone:918-299-1296
Practice Address - Fax:918-299-1534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2235111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherBCBS
OK=========001OtherBCBS
OKT75425Medicare UPIN