Healthcare Provider Details

I. General information

NPI: 1528364205
Provider Name (Legal Business Name): INTEGRATED PHYSICAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4564 S HARVARD AVE SUITE B
TULSA OK
74135-2918
US

IV. Provider business mailing address

4564 S HARVARD AVE SUITE B
TULSA OK
74135-2918
US

V. Phone/Fax

Practice location:
  • Phone: 918-231-7832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3877
License Number StateOK

VIII. Authorized Official

Name: DR. TYLER BACHMAN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 918-231-7832