Provider Demographics
NPI:1902827066
Name:PERTREE, MOLLIE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:MOLLIE
Middle Name:ANN
Last Name:PERTREE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MOLLIE
Other - Middle Name:ANN
Other - Last Name:ROAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1991 TOWER DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2388
Mailing Address - Country:US
Mailing Address - Phone:405-735-8282
Mailing Address - Fax:405-735-8262
Practice Address - Street 1:1991 TOWER DR
Practice Address - Street 2:SUITE G
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2388
Practice Address - Country:US
Practice Address - Phone:405-735-8282
Practice Address - Fax:405-735-8262
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor