Provider Demographics
NPI:1346310737
Name:BRIAN L. PREDMORE, D.C., P.C.
Entity Type:Organization
Organization Name:BRIAN L. PREDMORE, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PREDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-789-1100
Mailing Address - Street 1:7006 NW 36TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-3317
Mailing Address - Country:US
Mailing Address - Phone:405-789-1100
Mailing Address - Fax:405-789-1109
Practice Address - Street 1:7006 NW 36TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3317
Practice Address - Country:US
Practice Address - Phone:405-789-1100
Practice Address - Fax:405-789-1109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU05531Medicare UPIN
OK513744791PMedicare ID - Type Unspecified