Healthcare Provider Details

I. General information

NPI: 1427119478
Provider Name (Legal Business Name): TIMOTHY JOSHUA NIX D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/30/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 NORTH MAIN STREET
RED OAK OK
74563-6506
US

IV. Provider business mailing address

12150 NE 155TH RD
RED OAK OK
74563-5124
US

V. Phone/Fax

Practice location:
  • Phone: 918-448-6054
  • Fax:
Mailing address:
  • Phone: 918-448-6054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number4045
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: