Organization
BACK PAIN HOME SUPPLIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK EDMOND LOFTIS DC (PRESIDENT & CEO)
(918) 399-0089
Entity
Organization
Contact information
Practice address
116 S SKINNER AVE STE B, DRUMRIGHT, OK 74030-3642
(918) 352-9669
(844) 316-6726
Mailing address
PO BOX 752, DRUMRIGHT, OK 74030-0752
(918) 352-9669
(844) 316-6726
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/15/2016
Last updated
03/26/2019
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