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BACK TO HEALTH CHIROPRACTIC P C

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ROGER ALLEN DIVIS D.C. (PRESIDENT/OWNER)
(405) 258-0014
Entity
Organization

Contact information

Practice address
1206 MANVEL AVE STE B, CHANDLER, OK 74834-4401
(405) 258-0014
(405) 258-0094
Mailing address
PO BOX 128, CHANDLER, OK 74834-0128
(405) 258-0014
(405) 258-0094

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3592
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
446605938 003
BLUE CROSS/BLUE SHIELD
OK
01
P00135785 DB9021
RAILROAD MEDICARE
OK
Enumeration date
07/25/2006
Last updated
09/19/2007
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