Provider Demographics
NPI:1104372465
Name:PATEL, MANISHA (DC)
Entity Type:Individual
Prefix:
First Name:MANISHA
Middle Name:
Last Name:PATEL
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 1:1305 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3952
Mailing Address - Country:US
Mailing Address - Phone:405-519-5011
Mailing Address - Fax:
Practice Address - Street 1:3209 S BROADWAY
Practice Address - Street 2:STE 217
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4061
Practice Address - Country:US
Practice Address - Phone:405-726-8330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor