Provider Demographics
NPI:1982898433
Name:NOBLE CHIROPRACTIC CENTER P.C.
Entity type:Organization
Organization Name:NOBLE CHIROPRACTIC CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-872-5868
Mailing Address - Street 1:PO BOX 2065
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:OK
Mailing Address - Zip Code:73068-2065
Mailing Address - Country:US
Mailing Address - Phone:405-872-5868
Mailing Address - Fax:405-872-5887
Practice Address - Street 1:1101 PARKWOODS DR
Practice Address - Street 2:
Practice Address - City:NOBLE
Practice Address - State:OK
Practice Address - Zip Code:73068
Practice Address - Country:US
Practice Address - Phone:405-872-5868
Practice Address - Fax:405-872-5887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U35924Medicare UPIN
OK300522105Medicare PIN