Provider Demographics
NPI:1912126798
Name:CHIAF CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:CHIAF CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHIAF
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:405-721-1101
Mailing Address - Street 1:7741 W HEFNER RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-4304
Mailing Address - Country:US
Mailing Address - Phone:405-721-1101
Mailing Address - Fax:405-722-1029
Practice Address - Street 1:7741 W HEFNER RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-4304
Practice Address - Country:US
Practice Address - Phone:405-721-1101
Practice Address - Fax:405-722-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK443605879001OtherBLUE CROSS & BLUE SHIELD