Healthcare Provider Details

I. General information

NPI: 1043208234
Provider Name (Legal Business Name): ORVILLE LEE RAU DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 ELM AVE
YUKON OK
73099-2627
US

IV. Provider business mailing address

324 ELM AVE
YUKON OK
73099-2627
US

V. Phone/Fax

Practice location:
  • Phone: 405-354-5231
  • Fax: 405-354-2371
Mailing address:
  • Phone: 405-354-5231
  • Fax: 405-354-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2426
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: