Provider Demographics
NPI:1164517546
Name:DOAN, L DENNIS (DC)
Entity Type:Individual
Prefix:DR
First Name:L DENNIS
Middle Name:
Last Name:DOAN
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 1:12411 N ROCKWELL AV
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142
Mailing Address - Country:US
Mailing Address - Phone:405-621-5617
Mailing Address - Fax:405-621-5619
Practice Address - Street 1:12411 N ROCKWELL AV
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142
Practice Address - Country:US
Practice Address - Phone:405-621-5617
Practice Address - Fax:405-621-5619
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
800522067Medicare ID - Type Unspecified
OK090216Medicare ID - Type Unspecified