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General NPI Number Information
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NPI Number | 1215026273
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Entity Type | Individual
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Provider Name | JOHN BRADLEY EITZEN D.C.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 11/29/2018
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Provider Practice Location Address
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Address Line | 523 S INDEPENDENCE ST
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City | ENID
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State | OK
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Zip | 73701-5631
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Country | US
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Telephone | 580-237-5007
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Fax | 580-234-6851
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Provider Business Mailing Address
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Address Line | 123 W BROADWAY
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City | FAIRVIEW
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State | OK
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Zip | 73737-2009
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Country | US
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Telephone | 580-227-4200
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Fax | 580-234-6851
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3805
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License Number State | OK
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