Healthcare Provider Details

I. General information

NPI: 1972545903
Provider Name (Legal Business Name): BILL W. RAINS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W BROADWAY AVE SUITE 5
SULPHUR OK
73086-6507
US

IV. Provider business mailing address

2600 W BROADWAY AVE SUITE 5
SULPHUR OK
73086-6507
US

V. Phone/Fax

Practice location:
  • Phone: 580-622-8333
  • Fax: 580-622-8771
Mailing address:
  • Phone: 580-622-8333
  • Fax: 580-622-8771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1614
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: