Proactive Sport and Spine PLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3846 Issued in OK

Legal business name

PROACTIVE SPORT AND SPINE PLC

Practice address

4412 W Houston St
Broken Arrow, OK 74012-4645

Phone

(918) 254-8700

Fax

(918) 254-8711

NPI assigned

Apr 3, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Travis J Dearmon, D.C.NPI 1063603603

Title

Chiropractor

Phone

(918) 254-8700

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 1

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

• Travis J Dearmon, D.C.

  • Chiropractor
  • Broken Arrow, OK
  • NPI 1063603603
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1364947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364947200000",
    "number": "1114260593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4412 W HOUSTON",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "74012",
            "telephone_number": "918-254-8700",
            "fax_number": "918-254-8711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4412 W HOUSTON ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740124645",
            "telephone_number": "918-254-8700",
            "fax_number": "918-254-8711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE SPORT AND SPINE PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-03",
        "last_updated": "2013-04-03",
        "status": "A",
        "authorized_official_last_name": "DEARMON",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "918-254-8700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "3846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Apr 3, 2013; 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.