Organization
CLEVELAND CHIROPRACTIC CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
S J BLYTHE III DC (OWNER PRESIDENT)
(918) 358-3376
Entity
Organization
Contact information
Practice address
312 S BROADWAY STREET, CLEVELAND, OK 74020
(918) 358-3376
(918) 358-3376
Mailing address
312 S BROADWAY STREET, CLEVELAND, OK 74020
(918) 358-3376
(918) 358-3376
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2247
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
731237629001
BLUE CROSS BLUE SHIELD
OK
Enumeration date
02/12/2007
Last updated
08/22/2020
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