Provider Demographics
NPI:1306903463
Name:UNIVERSAL CHIROPRACTIC CLINIC, P.C.
Entity type:Organization
Organization Name:UNIVERSAL CHIROPRACTIC CLINIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORRISETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-425-1311
Mailing Address - Street 1:2819 N LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74110-1850
Mailing Address - Country:US
Mailing Address - Phone:918-425-1311
Mailing Address - Fax:918-425-1313
Practice Address - Street 1:2819 N LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74110-1850
Practice Address - Country:US
Practice Address - Phone:918-425-1311
Practice Address - Fax:918-425-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU64386Medicare UPIN