Provider Demographics
NPI:1902814171
Name:PANCRATZ, CHRIS A (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:A
Last Name:PANCRATZ
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 1:3139 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-8007
Mailing Address - Country:US
Mailing Address - Phone:918-748-4466
Mailing Address - Fax:918-748-4468
Practice Address - Street 1:3139 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-8007
Practice Address - Country:US
Practice Address - Phone:918-748-4466
Practice Address - Fax:918-748-4468
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU11157Medicare UPIN