Healthcare Provider Details

I. General information

NPI: 1245274760
Provider Name (Legal Business Name): DARREN LEE TIPTON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 S UNION AVE
TULSA OK
74107-7840
US

IV. Provider business mailing address

4940 S UNION AVE
TULSA OK
74107-7840
US

V. Phone/Fax

Practice location:
  • Phone: 918-447-6867
  • Fax: 918-447-0046
Mailing address:
  • Phone: 918-447-6867
  • Fax: 918-447-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3441
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: