Provider Demographics
NPI:1710056403
Name:BLEDSOE, EUGENE E (DC)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:E
Last Name:BLEDSOE
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 1:116 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-2412
Mailing Address - Country:US
Mailing Address - Phone:918-367-9600
Mailing Address - Fax:918-367-9699
Practice Address - Street 1:116 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-2412
Practice Address - Country:US
Practice Address - Phone:918-367-9600
Practice Address - Fax:918-367-9699
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU62650Medicare UPIN