Provider Demographics
NPI:1386697555
Name:CARVER CHIROPRACTIC CLINIC OF EDMOND, INC
Entity type:Organization
Organization Name:CARVER CHIROPRACTIC CLINIC OF EDMOND, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-348-2112
Mailing Address - Street 1:3015 E 44TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8135
Mailing Address - Country:US
Mailing Address - Phone:405-348-2112
Mailing Address - Fax:405-348-2549
Practice Address - Street 1:3015 E 44TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-8135
Practice Address - Country:US
Practice Address - Phone:405-348-2112
Practice Address - Fax:405-348-2549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5295Medicare PIN
OK=========Medicare UPIN