Provider Demographics
NPI:1316519705
Name:CHAMPION CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:CHAMPION CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SIERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-695-7599
Mailing Address - Street 1:177145 HIGHWAY 277
Mailing Address - Street 2:
Mailing Address - City:GERONIMO
Mailing Address - State:OK
Mailing Address - Zip Code:73543-5211
Mailing Address - Country:US
Mailing Address - Phone:580-695-7599
Mailing Address - Fax:
Practice Address - Street 1:177145 HIGHWAY 277
Practice Address - Street 2:
Practice Address - City:GERONIMO
Practice Address - State:OK
Practice Address - Zip Code:73543-5211
Practice Address - Country:US
Practice Address - Phone:580-695-7599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty