MEDICARE: STEVEN A LAUDENBACK DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3114	OK

General Provider Information

NPI Number	:	1346315546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN A LAUDENBACK DC

Provider Business Mailing Address
First Line	:	PO BOX 54051
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74155-0051
Country	:	US
Telephone Number	:	918-672-2773
Fax Number	:	918-439-0222

Provider Business Practice Location Address
First Line	:	913 N 161ST EAST AVE
Second Line	:	STE E
City	:	TULSA
State	:	OK
Zip	:	74116
Country	:	US
Telephone Number	:	918-672-2773
Fax Number	:	918-439-0222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	07/08/2007

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Directions to “ STEVEN A LAUDENBACK DC” Practice Location

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