Provider Demographics
NPI:1275674277
Name:XAIYARATT, TINNAKON N (DC)
Entity Type:Individual
Prefix:
First Name:TINNAKON
Middle Name:N
Last Name:XAIYARATT
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:PO BOX 471543
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74147-1543
Mailing Address - Country:US
Mailing Address - Phone:918-622-3100
Mailing Address - Fax:918-622-3103
Practice Address - Street 1:5436 S MINGO RD
Practice Address - Street 2:SUITE I
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5711
Practice Address - Country:US
Practice Address - Phone:918-622-3100
Practice Address - Fax:918-622-3103
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3827111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor