Provider Demographics
NPI:1609023589
Name:RICK MUSTAIN DC,PC
Entity Type:Organization
Organization Name:RICK MUSTAIN DC,PC
Other - Org Name:MUSTAIN CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MUSTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-751-0848
Mailing Address - Street 1:11201 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-6315
Mailing Address - Country:US
Mailing Address - Phone:405-751-0848
Mailing Address - Fax:
Practice Address - Street 1:11201 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6315
Practice Address - Country:US
Practice Address - Phone:405-751-0848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100832530AMedicaid
OK100832530AMedicaid
QDCGLMedicare PIN