Provider Demographics
NPI:1962772855
Name:FOUTZ CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:FOUTZ CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-283-2222
Mailing Address - Street 1:997 W WILL ROGERS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-5416
Mailing Address - Country:US
Mailing Address - Phone:918-283-2222
Mailing Address - Fax:918-341-6976
Practice Address - Street 1:997 W WILL ROGERS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5416
Practice Address - Country:US
Practice Address - Phone:918-283-2222
Practice Address - Fax:918-341-6976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty