Healthcare Provider Details

I. General information

NPI: 1902981376
Provider Name (Legal Business Name): CHRISTOPHER TODD PARK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 W VANDAMENT AVE STE 201
YUKON OK
73099-4666
US

IV. Provider business mailing address

1809 COMMONS CIR STE A
YUKON OK
73099-9528
US

V. Phone/Fax

Practice location:
  • Phone: 405-354-2084
  • Fax: 405-265-2582
Mailing address:
  • Phone: 405-577-6268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3191
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: