Healthcare Provider Details

I. General information

NPI: 1669502241
Provider Name (Legal Business Name): CHARLES FREDERICK ZOELLNER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4785 E 91ST ST SUITE B
TULSA OK
74137
US

IV. Provider business mailing address

4785 E 91ST ST SUITE B
TULSA OK
74137
US

V. Phone/Fax

Practice location:
  • Phone: 918-488-8600
  • Fax: 918-488-9604
Mailing address:
  • Phone: 918-488-8600
  • Fax: 918-488-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3812
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: