Organization · NPI-2

415 Main LLC

Chiropractor · Oklahoma City, OK

NPI number1093037046
StatusActive
Last updated in NPPESDec 11, 2017

Details

NPI
1093037046
Entity type
Organization (NPI-2)
Legal business name
415 Main LLC
Organization subpart
No
Enumeration date
Feb 18, 2010
Last updated
Dec 11, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
111N00000X Chiropractor3509OKYes

Practice location

10317 Greenbriar Pkwy
Oklahoma City, OK 73159-7648

Phone 405-378-3400 · Fax 866-323-7959

Mailing address

10317 Greenbriar Pkwy
Oklahoma City, OK 73159-7648

Phone 405-378-3400 · Fax 866-323-7959

Authorized official

Tracy Ellis
Owner
4056647622

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