Organization
GREEN COUNTRY SPINE & SPORT, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH CLARK DC (OWNER)
(918) 256-5111
Entity
Organization
Contact information
Practice address
803 N FOREMAN ST, VINITA, OK 74301-1435
(918) 256-5111
(918) 256-5222
Mailing address
PO BOX 248, VINITA, OK 74301-0248
(918) 256-5111
(918) 256-5222
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4016
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200449820A
—
OK
01
—
OKAAA2678
MEDICARE PTAN
OK
Enumeration date
10/25/2011
Last updated
08/27/2013
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