Provider Demographics
NPI:1437246741
Name:BEWLEY CHIROPRACTIC OF TULSA INC
Entity Type:Organization
Organization Name:BEWLEY CHIROPRACTIC OF TULSA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHRIOPRACTIC PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BEWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-627-1100
Mailing Address - Street 1:5802 S MEMORIAL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145
Mailing Address - Country:US
Mailing Address - Phone:918-627-1100
Mailing Address - Fax:918-627-6504
Practice Address - Street 1:5802 S MEMORIAL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145
Practice Address - Country:US
Practice Address - Phone:918-627-1100
Practice Address - Fax:918-627-6504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3063BEWLEY111N00000X
OK3811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK448668960 BOWLEYMedicare ID - Type Unspecified
OK435274697Medicare PIN