Provider Demographics
NPI:1750432274
Name:MARSHALL, RAYMOND P (DC)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:P
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6931 S 66TH EAST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1754
Mailing Address - Country:US
Mailing Address - Phone:918-523-0111
Mailing Address - Fax:918-523-0312
Practice Address - Street 1:6931 S 66TH EAST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1754
Practice Address - Country:US
Practice Address - Phone:918-523-0111
Practice Address - Fax:918-523-0312
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$ 001Medicare UPIN