Impact Chiropractic Clinic Inc PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2589 Issued in OK

Legal business name

IMPACT CHIROPRACTIC CLINIC INC PC

Practice address

4705 W Urbana St
Broken Arrow, OK 74012-5998

Phone

(918) 893-6400

Fax

(918) 893-6402

NPI assigned

Apr 25, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Kelley D Dehnhardt

Title

Office Manager

Phone

(918) 893-6400

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 2

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

• Corey Michael Stubbs, D.C.

  • Chiropractor
  • Tulsa, OK
  • NPI 1033220918
  Medicare reassignment Care Compare group NPD
• Timothy Tod Tregoning, D.C.

  • Chiropractor
  • Tulsa, OK
  • NPI 1437244746
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260835200000",
    "number": "1073732087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 W URBANA",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740125998",
            "telephone_number": "918-893-6400",
            "fax_number": "918-893-6402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 W URBANA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740125998",
            "telephone_number": "918-893-6400",
            "fax_number": "918-893-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT CHIROPRACTIC CLINIC INC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2009-12-15",
        "status": "A",
        "authorized_official_last_name": "DEHNHARDT",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "918-893-6400",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "2589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Anthony Hyland, PT, DPT
• Lydia Noel Hyslop, COTA/L
• Id Consultants PLLC
• Ignite Potential Physical Therapy and Wellness PLLC
• Imaging Partners of Tulsa LLC
• Lindsey Ince, MS, RD/LD
• Independence Technologies
• Individual and Family Matters LLC.
• Infinite Insight Inc
• Anthony Ingram

• Chiropractor in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Chiropractor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2009; 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.