Healthcare Provider Details

I. General information

NPI: 1174632525
Provider Name (Legal Business Name): ROBERT THOMAS VALLANDINGHAM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W BROADWAY AVE
SULPHUR OK
73086-4415
US

IV. Provider business mailing address

1205 W BROADWAY AVE
SULPHUR OK
73086-4415
US

V. Phone/Fax

Practice location:
  • Phone: 580-622-5959
  • Fax: 580-622-6108
Mailing address:
  • Phone: 580-622-5959
  • Fax: 580-622-6108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3692
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: