Organization
CHIROPRACTIC SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KERRY ELLIS (OFFICE ADMINISTRTOR)
(580) 223-4858
Entity
Organization
Contact information
Practice address
2400 N COMMERCE ST, SUITE 103, ARDMORE, OK 73401-1438
(580) 223-4858
(580) 226-6111
Mailing address
2400 N COMMERCE ST, SUITE 103, ARDMORE, OK 73401-1438
(580) 223-4858
(580) 226-6111
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
1596
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100713340B
—
OK
01
—
1689644544
DC NPI NUMBER
OK
01
—
526611643002
BLUE CROSS BLUE SHIELD
OK
01
—
9204749
CIGNA
OK
01
—
PENDING
MEDICARE ID
OK
Enumeration date
03/21/2007
Last updated
10/11/2011
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