Provider Demographics
NPI:1972704252
Name:ACCIDENT CARE CLINIC, INC.
Entity type:Organization
Organization Name:ACCIDENT CARE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-636-4078
Mailing Address - Street 1:8505 S. WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2007
Mailing Address - Country:US
Mailing Address - Phone:405-636-4078
Mailing Address - Fax:405-636-4079
Practice Address - Street 1:8505 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9209
Practice Address - Country:US
Practice Address - Phone:405-636-4078
Practice Address - Fax:405-636-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3462111N00000X
OK3421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU69797Medicare UPIN
OKU691118Medicare UPIN