Healthcare Provider Details

I. General information

NPI: 1033358163
Provider Name (Legal Business Name): CANDICE DALEK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6608 N WESTERN AVE PMB 347
NICHOLS HILLS OK
73116
US

IV. Provider business mailing address

6608 N WESTERN AVE PMB 347
NICHOLS HILLS OK
73116
US

V. Phone/Fax

Practice location:
  • Phone: 719-453-4630
  • Fax:
Mailing address:
  • Phone: 719-453-4630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5728
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4655
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: