Provider Demographics
NPI:1881817047
Name:DECLUE, THOMAS E (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:DECLUE
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 1:208 BULLDOG BLVD
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-1073
Mailing Address - Country:US
Mailing Address - Phone:918-396-3777
Mailing Address - Fax:918-396-3066
Practice Address - Street 1:208 BULLDOG BLVD
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-1073
Practice Address - Country:US
Practice Address - Phone:918-396-3777
Practice Address - Fax:918-396-3066
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243415300Medicare PIN