Healthcare Provider Details

I. General information

NPI: 1720168404
Provider Name (Legal Business Name): GEOFFREY E PIRTLE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E RUSSELL ST
EL RENO OK
73036-2740
US

IV. Provider business mailing address

211 E RUSSELL ST
EL RENO OK
73036-2740
US

V. Phone/Fax

Practice location:
  • Phone: 405-262-4878
  • Fax: 405-262-1122
Mailing address:
  • Phone: 405-262-4878
  • Fax: 405-262-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3344
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: