Provider Demographics
NPI:1932291275
Name:FIKE, DAVID WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WAYNE
Last Name:FIKE
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 1:4835 S FULTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6995
Mailing Address - Country:US
Mailing Address - Phone:918-664-8281
Mailing Address - Fax:918-664-8368
Practice Address - Street 1:4835 S FULTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6995
Practice Address - Country:US
Practice Address - Phone:918-664-8281
Practice Address - Fax:918-664-8368
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5725051OtherAETNA
OK10884537OtherCAQH ID#
OKU59502Medicare UPIN