Provider Demographics
NPI:1598744195
Name:SIBLEY, JOHN W JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:SIBLEY
Suffix:JR
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 1:3322 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3512
Mailing Address - Country:US
Mailing Address - Phone:918-749-5741
Mailing Address - Fax:918-745-9022
Practice Address - Street 1:3322 E 51ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3512
Practice Address - Country:US
Practice Address - Phone:918-749-5741
Practice Address - Fax:918-745-9022
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT80015Medicare UPIN
OKQDCCQMedicare PIN