Organization Active NPI

Prentice Family Chiropractic PLLC

  • Chiropractor
  • Jenks, OK
National Provider Identifier
1104991280
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3725 Issued in OK
Legal business name
PRENTICE FAMILY CHIROPRACTIC PLLC
Practice address
9428 S Elwood Ave
Suite 102
Jenks, OK 74037-2317
Phone
(918) 296-0525
Fax
(918) 296-0526
NPI assigned
Nov 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Amy Marie Prentice
Title
Office Manager
Phone
(918) 296-0525

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3725 OK Primary

Addresses

Primary practice location

9428 S Elwood Ave
Suite 102
Jenks, OK 74037-2317

Mailing address

9428 S Elwood Ave
Suite 102
Jenks, OK 74037-2317
Phone (918) 296-0525

Other identifiers 1

IdentifierTypeStateIssuer
443769532002OtherOKBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

9428 S Elwood Ave
Ste 102
Jenks, OK 74037
Phone (918) 296-0525

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": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104991280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9428 S ELWOOD AVE",
            "address_2": "SUITE 102",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740372317",
            "telephone_number": "918-296-0525",
            "fax_number": "918-296-0526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9428 S ELWOOD AVE",
            "address_2": "SUITE 102",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740372317",
            "telephone_number": "918-296-0525",
            "fax_number": "918-296-0526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRENTICE FAMILY CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PRENTICE",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "918-296-0525"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "3725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "443769532002",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jenks, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.