Provider Demographics
NPI:1851685416
Name:KEYS CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:KEYS CHIROPRACTIC CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:LAVERNE
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-510-9850
Mailing Address - Street 1:2600 E VANCOUVER ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-4629
Mailing Address - Country:US
Mailing Address - Phone:918-510-9850
Mailing Address - Fax:
Practice Address - Street 1:26251 HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:PARK HILL
Practice Address - State:OK
Practice Address - Zip Code:74451-3802
Practice Address - Country:US
Practice Address - Phone:918-510-9850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty