Provider Demographics
NPI:1891119517
Name:TALLEY CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:TALLEY CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:580-795-2269
Mailing Address - Street 1:411 N 1ST ST
Mailing Address - Street 2:P.O. BOX 342
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446-1404
Mailing Address - Country:US
Mailing Address - Phone:580-795-2269
Mailing Address - Fax:580-795-2609
Practice Address - Street 1:411 N 1ST ST
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-1404
Practice Address - Country:US
Practice Address - Phone:580-795-2269
Practice Address - Fax:580-795-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3169261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center