Provider Demographics
NPI:1154948073
Name:THRIVE CHIROPRACTIC GROUP 3 LLC
Entity type:Organization
Organization Name:THRIVE CHIROPRACTIC GROUP 3 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:PERTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-604-5295
Mailing Address - Street 1:8013 S WESTERN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2537
Mailing Address - Country:US
Mailing Address - Phone:405-604-5295
Mailing Address - Fax:405-604-5297
Practice Address - Street 1:1201 NW 178TH ST STE 119
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-4280
Practice Address - Country:US
Practice Address - Phone:405-604-5295
Practice Address - Fax:405-604-5297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty