Healthcare Provider Details

I. General information

NPI: 1881739043
Provider Name (Legal Business Name): MARION V STAUFFER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/09/2007
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

1919 E DUNKIN RD
CUSHING OK
74023-5793
US

V. Phone/Fax

Practice location:
  • Phone: 918-225-1973
  • Fax: 918-225-1988
Mailing address:
  • Phone: 918-225-7374
  • 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:
Title or Position:
Credential:
Phone: