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General NPI Number Information
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NPI Number | 1992730378
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Entity Type | Individual
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Provider Name | ALAN RUSSELL DEAN JR. D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 313 N 4TH ST SUITE 100
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City | PONCA CITY
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State | OK
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Zip | 74601-4554
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Country | US
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Telephone | 580-765-2455
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 N O ST
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City | BLACKWELL
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State | OK
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Zip | 74631-6310
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Country | US
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Telephone | 580-789-0489
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Fax |
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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 | 3264
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License Number State | OK
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