Provider Demographics
NPI:1265139836
Name:HUNDLEY, GRACIE MAY KRISTINE (DC)
Entity type:Individual
Prefix:
First Name:GRACIE
Middle Name:MAY KRISTINE
Last Name:HUNDLEY
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 1:2026 S HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-4509
Mailing Address - Country:US
Mailing Address - Phone:918-923-2037
Mailing Address - Fax:
Practice Address - Street 1:2026 S HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019-4509
Practice Address - Country:US
Practice Address - Phone:918-923-2037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty