Provider Demographics
NPI:1972638815
Name:TULSA FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:TULSA FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:DURRELL
Authorized Official - Last Name:COFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-271-4805
Mailing Address - Street 1:3515 E 31ST ST STE B
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-1520
Mailing Address - Country:US
Mailing Address - Phone:918-749-4263
Mailing Address - Fax:866-543-9680
Practice Address - Street 1:4520 S HARVARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2925
Practice Address - Country:US
Practice Address - Phone:918-743-7500
Practice Address - Fax:866-543-9680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3472OtherOK LICENSE
OK3472OtherOK LICENSE
OKU99552Medicare UPIN
OK241416106Medicare PIN