Provider Demographics
NPI:1841690831
Name:JAY CHIROPRACTIC HEALTH AND REHABILITATION, LLC
Entity type:Organization
Organization Name:JAY CHIROPRACTIC HEALTH AND REHABILITATION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:CA
Authorized Official - Phone:918-787-6700
Mailing Address - Street 1:80 W. 7TH ST.
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344
Mailing Address - Country:US
Mailing Address - Phone:918-787-6700
Mailing Address - Fax:
Practice Address - Street 1:80 W 7TH ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-3403
Practice Address - Country:US
Practice Address - Phone:918-787-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3331305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization