Provider Demographics
NPI:1053578401
Name:LAUDENBACK CHIROPRACTIC
Entity type:Organization
Organization Name:LAUDENBACK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAUDENBACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-672-2734
Mailing Address - Street 1:4322 E 66TH ST
Mailing Address - Street 2:3-I
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1642
Mailing Address - Country:US
Mailing Address - Phone:918-672-2734
Mailing Address - Fax:918-439-0222
Practice Address - Street 1:913 N 161ST EAST AVE
Practice Address - Street 2:E
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74116-4106
Practice Address - Country:US
Practice Address - Phone:918-672-2734
Practice Address - Fax:918-439-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty