Provider Demographics
NPI:1912085341
Name:FIELDS, BOBBY J (CHIROPRACTOR)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:J
Last Name:FIELDS
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S OSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:OK
Mailing Address - Zip Code:74029
Mailing Address - Country:US
Mailing Address - Phone:918-534-1232
Mailing Address - Fax:
Practice Address - Street 1:105 S OSAGE AVE
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:OK
Practice Address - Zip Code:74029
Practice Address - Country:US
Practice Address - Phone:918-534-1232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
730987656001OtherBLUE CROSS
730987656001OtherBLUE CROSS
T75121Medicare UPIN