Provider Demographics
NPI:1740378058
Name:PREDMORE, BRIAN L (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:PREDMORE
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 1:7006 NW 36TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-3317
Mailing Address - Country:US
Mailing Address - Phone:405-789-1100
Mailing Address - Fax:405-789-1109
Practice Address - Street 1:7006 NW 36TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3317
Practice Address - Country:US
Practice Address - Phone:405-789-1100
Practice Address - Fax:405-789-1109
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU05531Medicare UPIN
OKOK700586Medicare PIN