Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3869 | OK |
N | 111NN0400X | Neurology | 3869 | OK |
NPI | 1386817781 |
---|---|
Provider Name | Mr. Curtis Wayne Tillman |
First Address | Coweta, OK 74429 |
Second Address | Coweta, OK 74429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2008 |
Last Update Date | 20/11/2017 |