Provider Demographics
NPI:1659455517
Name:GILSTRAP, RUSSELL DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:DALE
Last Name:GILSTRAP
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:RUSSELL
Other - Middle Name:DALE
Other - Last Name:GILSTRAP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-FNP
Mailing Address - Street 1:3900 S 113TH WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-2724
Mailing Address - Country:US
Mailing Address - Phone:918-241-3901
Mailing Address - Fax:918-241-3902
Practice Address - Street 1:3900 S 113TH WEST AVE
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-2724
Practice Address - Country:US
Practice Address - Phone:918-241-3901
Practice Address - Fax:918-241-3902
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2449111N00000X
OK97265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily