Healthcare Provider Details

I. General information

NPI: 1891734984
Provider Name (Legal Business Name): AMANDA MUSE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MUSE D.C.

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 NE 23RD ST
MOORE OK
73160-8976
US

IV. Provider business mailing address

804 NE 23RD ST
MOORE OK
73160-8976
US

V. Phone/Fax

Practice location:
  • Phone: 405-794-5000
  • Fax: 405-794-5003
Mailing address:
  • Phone: 405-794-5000
  • Fax: 405-794-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3639
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: