Provider Demographics
NPI:1386754612
Name:OKMULGEE CHIROPRACTIC INC
Entity type:Organization
Organization Name:OKMULGEE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANTON
Authorized Official - Last Name:ZIEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-756-6595
Mailing Address - Street 1:408 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-5511
Mailing Address - Country:US
Mailing Address - Phone:918-756-6595
Mailing Address - Fax:918-756-6121
Practice Address - Street 1:408 E 7TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-5511
Practice Address - Country:US
Practice Address - Phone:918-756-6595
Practice Address - Fax:918-756-6121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1891111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T75172Medicare UPIN
QDBZCMedicare ID - Type Unspecified