Provider Demographics
NPI:1871030270
Name:TULSA CHIROPRACTIC REHAB, LLC
Entity Type:Organization
Organization Name:TULSA CHIROPRACTIC REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-600-2969
Mailing Address - Street 1:8252 S HARVARD AVE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-1646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8252 S HARVARD AVE
Practice Address - Street 2:SUITE 155
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-1646
Practice Address - Country:US
Practice Address - Phone:918-237-3978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4135111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty