Provider Demographics
NPI:1932240413
Name:B C OKLAND PC
Entity Type:Organization
Organization Name:B C OKLAND PC
Other - Org Name:OKLAND CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-749-5436
Mailing Address - Street 1:102 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2502
Mailing Address - Country:US
Mailing Address - Phone:218-749-5436
Mailing Address - Fax:218-749-2118
Practice Address - Street 1:102 1ST ST N
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2502
Practice Address - Country:US
Practice Address - Phone:218-749-5436
Practice Address - Fax:218-749-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN278M1OKOtherBCBS PIN
MN649065OtherCHIROCARE ID#
MN277M9OKOtherBCBS GROUP NUMBER
MN4401492OtherMEDICA PIN
MN516405200Medicaid
MN4401492OtherMEDICA PIN
MNU93515Medicare UPIN
MN277M9OKOtherBCBS GROUP NUMBER