Organization
415 MAIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY ELLIS DC (OWNER)
(405) 664-7622
Entity
Organization
Contact information
Practice address
10317 GREENBRIAR PKWY, OKLAHOMA CITY, OK 73159-7648
(405) 378-3400
(866) 323-7959
Mailing address
10317 GREENBRIAR PKWY, OKLAHOMA CITY, OK 73159-7648
(405) 378-3400
(866) 323-7959
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3509
OK
Other
Enumeration date
02/18/2010
Last updated
12/11/2017
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