Provider Demographics
NPI:1043332273
Name:TYSON, RICKY DON (DC)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:DON
Last Name:TYSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:804 W CURTIS DRIVE
Mailing Address - Street 2:#180
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110
Mailing Address - Country:US
Mailing Address - Phone:405-737-9528
Mailing Address - Fax:405-737-9528
Practice Address - Street 1:804 W CURTIS DRIVE
Practice Address - Street 2:#180
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110
Practice Address - Country:US
Practice Address - Phone:405-737-9528
Practice Address - Fax:405-737-9528
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor