Healthcare Provider Details

I. General information

NPI: 1508945932
Provider Name (Legal Business Name): EDWARD E ECHALK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S PERKINS RD SUITE 20
STILLWATER OK
74074-3651
US

IV. Provider business mailing address

211 S PERKINS RD SUITE 20
STILLWATER OK
74074-3651
US

V. Phone/Fax

Practice location:
  • Phone: 405-372-2400
  • Fax: 405-372-2439
Mailing address:
  • Phone: 405-372-2400
  • Fax: 405-372-2439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2624
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: