Provider Demographics
NPI:1447768544
Name:MCCORMICK, FALLON LACHERIA (DC)
Entity Type:Individual
Prefix:DR
First Name:FALLON
Middle Name:LACHERIA
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:FALLON
Other - Middle Name:LACHERIA
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7171 S BRADEN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6302
Mailing Address - Country:US
Mailing Address - Phone:918-960-0826
Mailing Address - Fax:
Practice Address - Street 1:7171 S BRADEN AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6302
Practice Address - Country:US
Practice Address - Phone:918-960-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor