MEDICARE: OKLAHOMA COUNTY CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1609596337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA COUNTY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	9820 NE 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73141-4208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9820 NE 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73141-4208
Country	:	US
Telephone Number	:	405-259-8001
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	HEATH OLDHAM
Credential	:	DC
Telephone Number	:	405-595-7670

Provider Enumeration Date	:	09/01/2022
Last Update Date	:	09/01/2022

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Directions to “OKLAHOMA COUNTY CHIROPRACTIC ” Practice Location

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