Provider Demographics
NPI:1952308850
Name:ZUGELDER, MICHAEL DWAYNE (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DWAYNE
Last Name:ZUGELDER
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 1:2608 W KENOSHA ST STE 344
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8952
Mailing Address - Country:US
Mailing Address - Phone:918-259-0001
Mailing Address - Fax:918-259-0001
Practice Address - Street 1:805 S 11TH ST STE B
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5714
Practice Address - Country:US
Practice Address - Phone:918-259-0001
Practice Address - Fax:918-259-0001
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQDCHNMedicare ID - Type Unspecified
OKT75212Medicare UPIN