Provider Demographics
NPI:1972726149
Name:OWASSO FAMILY CHIROPRACTIC, INC. PC
Entity type:Organization
Organization Name:OWASSO FAMILY CHIROPRACTIC, INC. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-272-9553
Mailing Address - Street 1:7901 N OWASSO EXPY
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-3333
Mailing Address - Country:US
Mailing Address - Phone:918-272-9553
Mailing Address - Fax:918-272-5358
Practice Address - Street 1:7901 N OWASSO EXPY
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-3333
Practice Address - Country:US
Practice Address - Phone:918-272-9553
Practice Address - Fax:918-272-5358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK194227204OtherNPI FOR DOCTOR
OK900522310Medicare ID - Type Unspecified
OK194227204OtherNPI FOR DOCTOR