Provider Demographics
NPI:1003383829
Name:MAHAN, DANA DENISE (DC)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:DENISE
Last Name:MAHAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 SW 102ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7539
Mailing Address - Country:US
Mailing Address - Phone:972-900-8668
Mailing Address - Fax:
Practice Address - Street 1:2316 SW 102ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7539
Practice Address - Country:US
Practice Address - Phone:972-900-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor