Provider Demographics
NPI:1386883965
Name:NORDSTROM CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:NORDSTROM CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:NORDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-341-2126
Mailing Address - Street 1:16135 N MAY AVE
Mailing Address - Street 2:STE. B
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8976
Mailing Address - Country:US
Mailing Address - Phone:405-341-2126
Mailing Address - Fax:405-341-2582
Practice Address - Street 1:16135 N MAY AVE
Practice Address - Street 2:STE. B
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-8976
Practice Address - Country:US
Practice Address - Phone:405-341-2126
Practice Address - Fax:405-341-2582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty