Healthcare Provider Details

I. General information

NPI: 1871790485
Provider Name (Legal Business Name): MEMORIAL ROAD CHIROPRACTIC
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

1001 W MEMORIAL RD STE 12
OKLAHOMA CITY OK
73114-2000
US

IV. Provider business mailing address

1001 W MEMORIAL RD STE 12
OKLAHOMA CITY OK
73114-2000
US

V. Phone/Fax

Practice location:
  • Phone: 405-752-5900
  • Fax: 405-752-5906
Mailing address:
  • Phone: 405-752-5900
  • Fax: 405-752-5906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3320
License Number StateOK

VIII. Authorized Official

Name: DR. WARREN ROBERT BLISHEN
Title or Position: CHIROPRACTIC
Credential: DC
Phone: 405-752-5900