Provider Demographics
NPI:1770644171
Name:DUCKWORTH, JOE A (DC)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:A
Last Name:DUCKWORTH
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 1:3600 NW 50TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5638
Mailing Address - Country:US
Mailing Address - Phone:405-946-7393
Mailing Address - Fax:405-946-7411
Practice Address - Street 1:3600 NW 50TH ST STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5638
Practice Address - Country:US
Practice Address - Phone:405-946-7393
Practice Address - Fax:405-946-7411
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor