Provider Demographics
NPI:1164523635
Name:PRINCE, ERIN NICOLE (DC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:NICOLE
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2537 S. KELLY AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013
Mailing Address - Country:US
Mailing Address - Phone:505-350-8480
Mailing Address - Fax:580-921-5640
Practice Address - Street 1:2537 S. KELLY AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:505-350-8480
Practice Address - Fax:580-921-5640
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1618111N00000X
OK4051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor