Provider Demographics
NPI:1356094270
Name:WOMACK, TY AUSTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:AUSTIN
Last Name:WOMACK
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 1:6929 S SOONER RD APT 45202
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-2745
Mailing Address - Country:US
Mailing Address - Phone:405-496-2169
Mailing Address - Fax:
Practice Address - Street 1:2276 36TH AVE NW STE 110
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-3279
Practice Address - Country:US
Practice Address - Phone:405-496-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor