Provider Demographics
NPI:1558615377
Name:MCGUIRE, CASEY DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:DEAN
Last Name:MCGUIRE
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 1:2908 W CANTON ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-0823
Mailing Address - Country:US
Mailing Address - Phone:918-899-7663
Mailing Address - Fax:
Practice Address - Street 1:601 S MISSION ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4657
Practice Address - Country:US
Practice Address - Phone:918-224-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor