Healthcare Provider Details

I. General information

NPI: 1073592010
Provider Name (Legal Business Name): BILL EARL MEAD III DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: WILLIAM EARL MEAD

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 ARNOLD ST 72MDG/SGOSC
TINKER AFB OK
73145-8105
US

IV. Provider business mailing address

6246 S UTICA AVE
TULSA OK
74136-0803
US

V. Phone/Fax

Practice location:
  • Phone: 405-736-2380
  • Fax: 405-736-2716
Mailing address:
  • Phone: 918-743-0659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1681
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: