Provider Demographics
NPI:1831193655
Name:PAGE, ANN ELIZABETH (DC)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:ELIZABETH
Last Name:PAGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:FORT GIBSON
Mailing Address - State:OK
Mailing Address - Zip Code:74434-0745
Mailing Address - Country:US
Mailing Address - Phone:918-478-3388
Mailing Address - Fax:918-478-3397
Practice Address - Street 1:1596 S LEE ST
Practice Address - Street 2:
Practice Address - City:FORT GIBSON
Practice Address - State:OK
Practice Address - Zip Code:74434-8403
Practice Address - Country:US
Practice Address - Phone:918-478-3388
Practice Address - Fax:918-478-3397
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3322OtherLICENSE NUMBER