Provider Demographics
NPI:1437244746
Name:TREGONING, TIMOTHY TOD (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:TOD
Last Name:TREGONING
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 1:4705 W URBANA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5998
Mailing Address - Country:US
Mailing Address - Phone:918-893-6400
Mailing Address - Fax:918-893-6402
Practice Address - Street 1:11014 E. 51 ST.
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146
Practice Address - Country:US
Practice Address - Phone:918-664-2412
Practice Address - Fax:918-664-2433
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU59505Medicare UPIN
OK2500522004Medicare ID - Type Unspecified