Healthcare Provider Details

I. General information

NPI: 1679574628
Provider Name (Legal Business Name): MARION V STAUFFER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 E MAIN ST
CUSHING OK
74023
US

IV. Provider business mailing address

1236 E MAIN ST
CUSHING OK
74023
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2603
License Number StateOK

VIII. Authorized Official

Name: DR. MARION V STAUFFER
Title or Position: OWNER, CHIROPRACTOR
Credential: DC
Phone: 918-225-1973