| NPI | 1205591708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN LEE ROADHOUSE Owner/President 918-481-2772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 207L00000X Anesthesiology |
| 261QP2000X Clinic/Center, Physical Therapy | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2021-11-01 |