Healthcare Provider Details

I. General information

NPI: 1558587980
Provider Name (Legal Business Name): FIKE CHIROPRACTIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4835 S FULTON AVE SUITE 102
TULSA OK
74135-6995
US

IV. Provider business mailing address

4835 SOUTH FULTON AVENUE SUITE 102
TULSA OK
74135
US

V. Phone/Fax

Practice location:
  • Phone: 918-664-8281
  • Fax: 918-664-8368
Mailing address:
  • Phone: 918-664-8281
  • Fax: 918-664-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3269
License Number StateOK

VIII. Authorized Official

Name: DR. DAVID WAYNE FIKE
Title or Position: DOCTOR
Credential: D.C.
Phone: 918-664-8281