Provider Demographics
NPI:1073592010
Name:MEAD, BILL EARL III (DC)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:EARL
Last Name:MEAD
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:EARL
Other - Last Name:MEAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6246 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-0803
Mailing Address - Country:US
Mailing Address - Phone:918-743-0659
Mailing Address - Fax:
Practice Address - Street 1:5700 ARNOLD ST
Practice Address - Street 2:72MDG/SGOSC
Practice Address - City:TINKER AFB
Practice Address - State:OK
Practice Address - Zip Code:73145-8105
Practice Address - Country:US
Practice Address - Phone:405-736-2380
Practice Address - Fax:405-736-2716
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQDBSTMedicare ID - Type Unspecified