Healthcare Provider Details

I. General information

NPI: 1194703454
Provider Name (Legal Business Name): FREDRICK JOHN HUSKEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FREDRICK JOHN HUSKEY D.C.

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 E. 51 ST STE A
TULSA OK
74135
US

IV. Provider business mailing address

3820 E. 51 ST STE A
TULSA OK
74135
US

V. Phone/Fax

Practice location:
  • Phone: 918-747-0939
  • Fax: 918-747-3939
Mailing address:
  • Phone: 918-747-0939
  • Fax: 918-747-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3054
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number3054
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3054
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: