Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3980 | OK |
NPI | 1003133075 |
---|---|
Provider Name | Maggie A. Pack |
First Address | Park Hill, OK 74451-3802 |
Second Address | Park Hill, OK 74451-3802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2010 |
Last Update Date | 20/05/2014 |