Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3054 | OK |
N | 111NR0200X | Radiology | 3054 | OK |
N | 213ER0200X | Radiology | 3054 | OK |
N | 111NS0005X | Chiropractic Sports Physician | 3054 | OK |
NPI | 1194703454 |
---|---|
Provider Name | Fredrick John Huskey |
First Address | Tulsa, OK 74135 |
Second Address | Tulsa, OK 74135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 25/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T79957 | (02) |