Provider Demographics
NPI:1912936667
Name:CHIROPRACTIC PHYSICIANS CLINIC
Entity Type:Organization
Organization Name:CHIROPRACTIC PHYSICIANS CLINIC
Other - Org Name:OKLAHOMA HEALTH AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-774-2214
Mailing Address - Street 1:4200 CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-9614
Mailing Address - Country:US
Mailing Address - Phone:580-774-2214
Mailing Address - Fax:580-774-2843
Practice Address - Street 1:4200 CARRIAGE WAY
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-9614
Practice Address - Country:US
Practice Address - Phone:580-774-2214
Practice Address - Fax:580-774-2843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========Medicare PIN