Provider Demographics
NPI:1114210556
Name:COTTINGAME, JANNA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JANNA
Middle Name:MARIE
Last Name:COTTINGAME
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 1:1259 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2119
Mailing Address - Country:US
Mailing Address - Phone:580-920-2555
Mailing Address - Fax:
Practice Address - Street 1:3004 W UNIVERSITY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2999
Practice Address - Country:US
Practice Address - Phone:580-920-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKDC4029111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor