Organization Active NPI

Maynard Family Chiropractic

  • Chiropractor
  • Tulsa, OK
National Provider Identifier
1053678508
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3994 Issued in OK
Legal business name
MAYNARD FAMILY CHIROPRACTIC
Practice address
8922 S Memorial Dr Ste C1
Tulsa, OK 74133-4343
Phone
(918) 872-8653
NPI assigned
Apr 20, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Philip Cameron Maynard, DCNPI 1215239066
Title
Doctor/Owner
Phone
(918) 872-8653

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3994 OK Primary

Addresses

Primary practice location

8922 S Memorial Dr Ste C1
Tulsa, OK 74133-4343

Mailing address

8922 S Memorial Dr Ste C1
Tulsa, OK 74133-4343
Phone (918) 872-8653

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120802000424 OK Part B Supplier - Clinic/Group Practice 6103072475 Receives reassigned benefits from 2 practitioners
Practice locations: Broken Arrow, OK

National Provider Directory

National Provider Directory

Locations

8922 S Memorial Dr
Ste C1
Tulsa, OK 74133
Phone (918) 704-3999

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719273600000",
    "number": "1053678508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8922 S MEMORIAL DR STE C1",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741334343",
            "telephone_number": "918-872-8653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8922 S MEMORIAL DR STE C1",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741334343",
            "telephone_number": "918-872-8653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYNARD FAMILY CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-20",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A",
        "authorized_official_last_name": "MAYNARD",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "CAMERON",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "918-872-8653",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "3994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.