Provider Demographics
NPI:1447477021
Name:TODD PARK, Y.C.C., INC.
Entity type:Organization
Organization Name:TODD PARK, Y.C.C., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-354-2084
Mailing Address - Street 1:401 W VANDAMENT AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-4654
Mailing Address - Country:US
Mailing Address - Phone:405-354-2084
Mailing Address - Fax:405-265-2582
Practice Address - Street 1:401 W VANDAMENT AVE
Practice Address - Street 2:STE 103
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4654
Practice Address - Country:US
Practice Address - Phone:405-354-2084
Practice Address - Fax:405-265-2582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK466759190-004OtherBCBS
OK360605OtherACN
OK3487525OtherAETNA