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General NPI Number Information
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NPI Number | 1659763837
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Entity Type | Organization
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Legal Business Name | DIB CHIROPRACTIC & WELLNESS PLLC
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 804 16TH AVE NW
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City | ARDMORE
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State | OK
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Zip | 73401-1818
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Country | US
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Telephone | 580-223-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 N COMMERCE ST
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City | ARDMORE
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State | OK
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Zip | 73401-1382
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Country | US
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Telephone | 580-223-5900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LYNDSI BEARD
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Credential | D.C,
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Telephone | 580-223-5900
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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 | 4188
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License Number State | OK
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