Provider Demographics
NPI:1497073159
Name:SCHOLLE, MITSUKO DEANA (DC)
Entity Type:Individual
Prefix:DR
First Name:MITSUKO
Middle Name:DEANA
Last Name:SCHOLLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2251 E SKELLY DR
Mailing Address - Street 2:101
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6062
Mailing Address - Country:US
Mailing Address - Phone:918-933-5270
Mailing Address - Fax:918-933-5246
Practice Address - Street 1:2251 E SKELLY DR
Practice Address - Street 2:101
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6062
Practice Address - Country:US
Practice Address - Phone:918-933-5270
Practice Address - Fax:918-933-5246
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3956111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor