Healthcare Provider Details

I. General information

NPI: 1518054832
Provider Name (Legal Business Name): RICK ALAN BEWLEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
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 TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3063
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: