Provider Demographics
NPI:1922037027
Name:RATZLAFF, MYRON DALE (DC)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:DALE
Last Name:RATZLAFF
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:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-0459
Mailing Address - Country:US
Mailing Address - Phone:918-322-3000
Mailing Address - Fax:918-322-3012
Practice Address - Street 1:14226 S ELM ST
Practice Address - Street 2:#2
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-3525
Practice Address - Country:US
Practice Address - Phone:918-322-3000
Practice Address - Fax:918-322-3012
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor