Provider Demographics
NPI:1376660316
Name:BACK2HEALTH OF TULSA P.C.
Entity Type:Organization
Organization Name:BACK2HEALTH OF TULSA P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:RATZLAFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-322-3000
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-0459
Mailing Address - Country:US
Mailing Address - Phone:918-322-3000
Mailing Address - Fax:918-322-3012
Practice Address - Street 1:14226 S ELM ST
Practice Address - Street 2:#2
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-3525
Practice Address - Country:US
Practice Address - Phone:918-322-3000
Practice Address - Fax:918-322-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3305261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU63490Medicare UPIN