Central Oklahoma Chiropractic Clinic Inc

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3465 Issued in OK

Legal business name

CENTRAL OKLAHOMA CHIROPRACTIC CLINIC INC

Practice address

602 N Broadway St
Tecumseh, OK 74873-2020

Phone

(405) 598-6768

Fax

(405) 597-6770

NPI assigned

Aug 7, 2007

Last updated

Jul 24, 2012By 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

Dr. Justin Ray Phillips, DCNPI 1295821874

Title

President

Phone

(405) 598-6768

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Practitioners 2

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.

• Justin Ray Phillips, D.C.

  • Chiropractor
  • Teucumseh, OK
  • NPI 1295821874
  Medicare reassignment NPD Authorized official
• Angela Lacynda Phillips

  • Counselor
  • Tecumseh, OK
  • NPI 1316319510
  NPD (past)

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

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343088000000",
    "number": "1174714877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 N BROADWAY ST",
            "address_2": "PO BOX 589",
            "city": "TECUMSEH",
            "state": "OK",
            "postal_code": "748732020",
            "telephone_number": "405-598-6768",
            "fax_number": "405-597-6770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 N BROADWAY ST",
            "city": "TECUMSEH",
            "state": "OK",
            "postal_code": "748732020",
            "telephone_number": "405-598-6768",
            "fax_number": "405-597-6770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL OKLAHOMA CHIROPRACTIC CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-07",
        "last_updated": "2012-07-24",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-598-6768",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "3465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Raychelle Brown
• Christa Lynn Bryce
• Chelsea Campbell
• Kyle Belvin Cantrell
• Melissa Capps
• Gerardo Cervantes
• Timothy Ray Chandler, LPN
• Jarred James Coffman
• Country Road Operations LLC
• Tristan Dirksen

• Chiropractor in Tecumseh, OK
• Providers in Tecumseh, OK by specialty
• Chiropractor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2012; 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.