Provider Demographics
NPI:1154997989
Name:MOVEMENT LABORATORY
Entity type:Organization
Organization Name:MOVEMENT LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HORACE
Authorized Official - Last Name:KEEFE
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:918-300-4084
Mailing Address - Street 1:5129 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-6307
Mailing Address - Country:US
Mailing Address - Phone:918-740-4183
Mailing Address - Fax:
Practice Address - Street 1:9238 S SHERIDAN RD STE C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5434
Practice Address - Country:US
Practice Address - Phone:918-300-4084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4128OtherSTATE LICENSE NUMBER