Provider Demographics
NPI:1609350057
Name:POWELL, CODY BLAINE (DC)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:BLAINE
Last Name:POWELL
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 1:1020 LAWSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:OK
Mailing Address - Zip Code:74536
Mailing Address - Country:US
Mailing Address - Phone:918-569-4143
Mailing Address - Fax:
Practice Address - Street 1:1020 LAWSON BLVD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:OK
Practice Address - Zip Code:74536
Practice Address - Country:US
Practice Address - Phone:918-569-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4299111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor