Provider Demographics
NPI:1245297670
Name:BRISTOW, REBECCA MARCELLE (DC)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MARCELLE
Last Name:BRISTOW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-4327
Mailing Address - Country:US
Mailing Address - Phone:580-363-4226
Mailing Address - Fax:580-363-3996
Practice Address - Street 1:122 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-4327
Practice Address - Country:US
Practice Address - Phone:580-363-4226
Practice Address - Fax:580-363-3996
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor