Provider Demographics
NPI:1952724833
Name:ALIGN CHIROPRACTIC AND WELLNESS, PLLC
Entity type:Organization
Organization Name:ALIGN CHIROPRACTIC AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:GOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-317-1754
Mailing Address - Street 1:2100 HARPER ST
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-8055
Mailing Address - Country:US
Mailing Address - Phone:405-281-6304
Mailing Address - Fax:405-281-6305
Practice Address - Street 1:2100 HARPER ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8055
Practice Address - Country:US
Practice Address - Phone:405-281-6304
Practice Address - Fax:405-281-6305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4133111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1114355294OtherINDIVIDUAL NPI
321962YWA4OtherMEDICARE ID