Healthcare Provider Details

I. General information

NPI: 1972740264
Provider Name (Legal Business Name): HEALING LIFE CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 E 11TH ST SUITE A
TULSA OK
74120-4602
US

IV. Provider business mailing address

1335 E 11TH ST SUITE A
TULSA OK
74120-4602
US

V. Phone/Fax

Practice location:
  • Phone: 918-500-4452
  • Fax:
Mailing address:
  • Phone: 918-500-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number3737
License Number StateOK

VIII. Authorized Official

Name: DR. SHANNON GULBRANSON
Title or Position: AUTHORIZED OFFICIAL
Credential: D.C.
Phone: 918-500-4452