Provider Demographics
NPI:1447640479
Name:MTP CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MTP CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERTREE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-735-8282
Mailing Address - Street 1:1991 TOWER DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2388
Mailing Address - Country:US
Mailing Address - Phone:405-735-8282
Mailing Address - Fax:405-735-8262
Practice Address - Street 1:1991 TOWER DR
Practice Address - Street 2:SUITE G
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2388
Practice Address - Country:US
Practice Address - Phone:405-735-8282
Practice Address - Fax:405-735-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1902827066OtherBLUE CROSS/BLUE SHIELD