Healthcare Provider Details

I. General information

NPI: 1528018306
Provider Name (Legal Business Name): JAMES WILLIAM TALLEY JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N 1ST ST
MADILL OK
73446-1404
US

IV. Provider business mailing address

411 N 1ST ST
MADILL OK
73446-1404
US

V. Phone/Fax

Practice location:
  • Phone: 580-795-2269
  • Fax: 580-795-2609
Mailing address:
  • Phone: 580-795-2269
  • Fax: 580-795-2609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3169
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: