Healthcare Provider Details

I. General information

NPI: 1831396589
Provider Name (Legal Business Name): DYNAMIC HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1083 N HARRAH RD
HARRAH OK
73045-9692
US

IV. Provider business mailing address

PO BOX 739
HARRAH OK
73045-0739
US

V. Phone/Fax

Practice location:
  • Phone: 405-454-6400
  • Fax: 925-475-2988
Mailing address:
  • Phone: 405-454-6400
  • Fax: 925-475-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3668
License Number StateOK

VIII. Authorized Official

Name: DR. DAMON COFFMAN
Title or Position: OWNER
Credential: D.C.
Phone: 405-454-6400