Provider Demographics
NPI:1386817781
Name:TILLMAN, CURTIS WAYNE (DC, DACNB)
Entity Type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:WAYNE
Last Name:TILLMAN
Suffix:
Gender:M
Credentials:DC, DACNB
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 608
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429
Mailing Address - Country:US
Mailing Address - Phone:918-486-1490
Mailing Address - Fax:918-486-1595
Practice Address - Street 1:29692 E STATE HWY 51
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429
Practice Address - Country:US
Practice Address - Phone:918-486-1490
Practice Address - Fax:918-486-1595
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3869111N00000X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5060Medicare PIN