Provider Demographics
NPI:1215122387
Name:CUMULATIVE TRAUMA TREATMENT CENTER
Entity type:Organization
Organization Name:CUMULATIVE TRAUMA TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-703-4550
Mailing Address - Street 1:13316 S WESTERN AVE
Mailing Address - Street 2:SUITE Q
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7302
Mailing Address - Country:US
Mailing Address - Phone:405-703-4550
Mailing Address - Fax:405-703-4552
Practice Address - Street 1:13316 S WESTERN AVE
Practice Address - Street 2:SUITE Q
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-7302
Practice Address - Country:US
Practice Address - Phone:405-703-4550
Practice Address - Fax:405-703-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty