Healthcare Provider Details

I. General information

NPI: 1275722167
Provider Name (Legal Business Name): NATURAL CHOICE CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 E MAIN ST
CUSHING OK
74023-3000
US

IV. Provider business mailing address

1236 E MAIN ST
CUSHING OK
74023-3000
US

V. Phone/Fax

Practice location:
  • Phone: 918-225-1973
  • Fax: 918-225-1988
Mailing address:
  • Phone: 918-225-1973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3772
License Number StateOK

VIII. Authorized Official

Name: DR. ROBERT D MULLINS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 918-225-1973