Provider Demographics
NPI:1124276944
Name:FAVORITE CHIROPRACTIC
Entity type:Organization
Organization Name:FAVORITE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:FAVORITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-953-7896
Mailing Address - Street 1:14101 N MAY AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-5071
Mailing Address - Country:US
Mailing Address - Phone:405-753-9793
Mailing Address - Fax:405-753-9769
Practice Address - Street 1:14101 N MAY AVE STE 105
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-5071
Practice Address - Country:US
Practice Address - Phone:405-753-9793
Practice Address - Fax:405-753-9769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty