Provider Demographics
NPI:1023606720
Name:918 CHIROPRACTIC SOUTH
Entity type:Organization
Organization Name:918 CHIROPRACTIC SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GRISWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-212-8688
Mailing Address - Street 1:1320 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-5804
Mailing Address - Country:US
Mailing Address - Phone:918-212-8688
Mailing Address - Fax:866-352-5122
Practice Address - Street 1:201 W MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3939
Practice Address - Country:US
Practice Address - Phone:918-212-8688
Practice Address - Fax:866-352-5122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:918 CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-07
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty