Provider Demographics
NPI:1871652909
Name:Y-KNOT CORPORATION
Entity type:Organization
Organization Name:Y-KNOT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:YANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-341-7246
Mailing Address - Street 1:911 S BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5743
Mailing Address - Country:US
Mailing Address - Phone:405-341-7246
Mailing Address - Fax:405-341-7958
Practice Address - Street 1:911 S BRYANT AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5743
Practice Address - Country:US
Practice Address - Phone:405-341-7246
Practice Address - Fax:405-341-7958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK446587758Medicare ID - Type Unspecified
OKT80056Medicare UPIN