Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 3685 | OK |
NPI | 1205939444 |
---|---|
Provider Name | Ben Daniel Beeler |
First Address | Tulsa, OK 74133-6313 |
Second Address | Tulsa, OK 74133-6313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 14/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U98931 | (02) | OK |