Healthcare Provider Details

I. General information

NPI: 1932291275
Provider Name (Legal Business Name): DAVID WAYNE FIKE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 04/26/2012
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 S FULTON AVE SUITE 102
TULSA OK
74135-6995
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:
Title or Position:
Credential:
Phone: