Organization Active NPI

Pmo Yukon, PLLC

  • Chiropractor
  • Yukon, OK
National Provider Identifier
1457038598
Registry record updated Jun 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
PMO YUKON, PLLC
Practice address
815 E Main St Ste 120
Yukon, OK 73099-2171
Phone
(405) 923-8897
NPI assigned
Jun 30, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2023

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

Authorized official

Name
Brant Koenig, DCNPI 1619079332
Title
Chiropractor
Phone
(405) 726-2727

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

815 E Main St Ste 120
Yukon, OK 73099-2171

Mailing address

800 W 18TH St Ste 120
Edmond, OK 73013-3759
Phone (405) 923-8897

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231026004393 OK Part B Supplier - Clinic/Group Practice 4587010574 Receives reassigned benefits from 2 practitioners
Practice locations: Yukon, OK

National Provider Directory

National Provider Directory

Locations

815 E Main St
Ste 120
Yukon, OK 73099
Phone (405) 210-2202

Practitioners & affiliated clinicians

Practitioners 3

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": "1688083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688083200000",
    "number": "1457038598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 W 18TH ST STE 120",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133759",
            "telephone_number": "405-923-8897",
            "fax_number": "405-216-5724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 E MAIN ST STE 120",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730992171",
            "telephone_number": "405-923-8897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMO YUKON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-30",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A",
        "authorized_official_last_name": "KOENIG",
        "authorized_official_first_name": "BRANT",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "405-726-2727",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yukon, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.