Healthcare Provider Details

I. General information

NPI: 1437246741
Provider Name (Legal Business Name): BEWLEY CHIROPRACTIC OF TULSA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 S MEMORIAL
TULSA OK
74145
US

IV. Provider business mailing address

5802 S MEMORIAL
TULSA OK
74145
US

V. Phone/Fax

Practice location:
  • Phone: 918-627-1100
  • Fax: 918-627-6504
Mailing address:
  • Phone: 918-627-1100
  • Fax: 918-627-6504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3063BEWLEY
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3811
License Number StateOK

VIII. Authorized Official

Name: MR. RICK ALAN BEWLEY
Title or Position: CHRIOPRACTIC PHYSICIAN
Credential: DC
Phone: 918-627-1100