Organization Name: | GREEN COUNTRY SPINE & SPORT, PLLC |
NPI Number: | 1942586706 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSEPH CLARK (OWNER) |
Mailing Address: | 803 N Foreman St Vinita |
State: | OK US |
Postal Code: | 743011435 |
Phone Number: | 9182565111 |
Fax Number: | 9182565222 |
NPI Enumeration Date: | 10/25/2011 |
NPI Last Update Date: | 08/27/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 4016 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |