Central Oklahoma Chiropractic Clinic Inc
Organization Active NPI Chiropractor · Tecumseh, OK
NPI 1174714877 · NPPES record last updated Jul 24, 2012
Key facts
- NPI
- 1174714877
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 3465 (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
- Organization subpart
- No
Authorized official
- Name
- Dr. Justin Ray Phillips, DC
- Title
- President
- Phone
- (405) 598-6768
Practitioners 2
-
Justin Ray Phillips, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120723000580 | OK | Part B Supplier - Clinic/Group Practice | 6901062751 |
Receives reassigned benefits from 1 practitioner Practice locations: Tecumseh, OK |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 3465 | OK | Yes |
Addresses
Primary practice location
602 N Broadway St
Tecumseh, OK 74873-2020
Mailing address
602 N Broadway St
PO Box 589
Tecumseh, OK 74873-2020
Phone (405) 598-6768
Other providers in Tecumseh, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.