Provider Demographics
NPI:1508063116
Name:BLISHEN, WARREN ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:ROBERT
Last Name:BLISHEN
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 1:1001 W MEMORIAL RD
Mailing Address - Street 2:STE 12
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-2000
Mailing Address - Country:US
Mailing Address - Phone:405-752-5900
Mailing Address - Fax:405-752-5906
Practice Address - Street 1:1001 W MEMORIAL RD
Practice Address - Street 2:STE 12
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-2000
Practice Address - Country:US
Practice Address - Phone:405-752-5900
Practice Address - Fax:405-752-5906
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3320111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200235109003OtherBCBS