Healthcare Provider Details

I. General information

NPI: 1639186505
Provider Name (Legal Business Name): MARY PATRICIA CUPIT D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 NW CACHE RD SUITE 1
LAWTON OK
73505-3300
US

IV. Provider business mailing address

5525 NW CACHE RD SUITE 1
LAWTON OK
73505-3300
US

V. Phone/Fax

Practice location:
  • Phone: 580-355-1000
  • Fax: 580-355-4025
Mailing address:
  • Phone: 580-355-1000
  • Fax: 580-355-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3633
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: