Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2448 | OK |
NPI | 1184798050 |
---|---|
Provider Name | Dr. Tracy L. Standridge |
First Address | Owasso, OK 74055 |
Second Address | Owasso, OK 74055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 29/03/2010 |