415 Main LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3509 Issued in OK

Legal business name

415 MAIN LLC

Practice address

10317 Greenbriar Pkwy
Oklahoma City, OK 73159-7648

Phone

(405) 378-3400

Fax

(866) 323-7959

NPI assigned

Feb 18, 2010

Last updated

Dec 11, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tracy Ellis, DCNPI 1679895700

Title

Owner

Phone

(405) 664-7622

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tracy Ellis, DC

  • Chiropractor
  • Oklahoma City, OK
  • NPI 1679895700
  Authorized official Same address or phone

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

{
    "created_epoch": "1266451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512950400000",
    "number": "1093037046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10317 GREENBRIAR PKWY",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731597648",
            "telephone_number": "405-378-3400",
            "fax_number": "866-323-7959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10317 GREENBRIAR PKWY",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731597648",
            "telephone_number": "405-378-3400",
            "fax_number": "866-323-7959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "415 MAIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-18",
        "last_updated": "2017-12-11",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-664-7622",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "3509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Oklahoma City, OK
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• Chiropractor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.