Provider Demographics
NPI:1033220918
Name:STUBBS, COREY MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:MICHAEL
Last Name:STUBBS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9709 E 79TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4566
Mailing Address - Country:US
Mailing Address - Phone:918-994-4048
Mailing Address - Fax:918-994-4090
Practice Address - Street 1:9709 E 79TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4566
Practice Address - Country:US
Practice Address - Phone:918-994-4000
Practice Address - Fax:918-994-4090
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK248323801Medicare PIN