Provider Demographics
NPI:1558587980
Name:FIKE CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:FIKE CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FIKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-664-8281
Mailing Address - Street 1:4835 SOUTH FULTON AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135
Mailing Address - Country:US
Mailing Address - Phone:918-664-8281
Mailing Address - Fax:918-664-8368
Practice Address - Street 1:4835 S FULTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6995
Practice Address - Country:US
Practice Address - Phone:918-664-8281
Practice Address - Fax:918-664-8368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK447783003001OtherBLUE CROSS BLUE SHIELD
OK5725051OtherAETNA
OKU59502Medicare UPIN
OK4477830038Medicare ID - Type Unspecified