Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4298 | OK |
NPI | 1003383829 |
---|---|
Provider Name | Dr. Dana Denise Mahan |
First Address | Oklahoma City, OK 73159-7539 |
Second Address | Oklahoma City, OK 73159-7539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2018 |
Last Update Date | 30/10/2018 |