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General NPI Number Information
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NPI Number | 1578748133
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Entity Type | Organization
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Legal Business Name | SPINAL DECOMPRESSION CENTER OF TULSA, LLC
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 6951 E 71ST ST
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City | TULSA
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State | OK
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Zip | 74133-2757
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Country | US
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Telephone | 918-481-0655
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Fax | 918-481-8729
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Provider Business Mailing Address
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Address Line | 6951 E 71ST ST
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City | TULSA
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State | OK
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Zip | 74133-2757
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Country | US
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Telephone | 918-481-0655
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Fax | 918-481-8729
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MICHAEL LEE PETERSON
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Credential | D.O.
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Telephone | 918-481-0655
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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 |
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License Number State |
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