Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3629 | OK |
N | 111NR0400X | Rehabilitation Chiropractor | 3629 | OK |
N | 111NS0005X | Chiropractic Sports Physician | 3629 | OK |
NPI | 1043259393 |
---|---|
Provider Name | Dr. Michael K Van Antwerp |
First Address | Tulsa, OK 74105-7105 |
Second Address | Tulsa, OK 74105-7105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 21/10/2021 |