Healthcare Provider Details

I. General information

NPI: 1205939444
Provider Name (Legal Business Name): BEN DANIEL BEELER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6117 S MINGO RD STE C
TULSA OK
74133-6313
US

IV. Provider business mailing address

6117 S MINGO RD STE C
TULSA OK
74133-6313
US

V. Phone/Fax

Practice location:
  • Phone: 918-615-3433
  • Fax: 918-615-3453
Mailing address:
  • Phone: 918-615-3433
  • Fax: 918-615-3433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3685
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: