MEDICARE: DR. JEFFERY LYNN MUSSMAN DC

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	3460	OK

General Provider Information

NPI Number	:	1750315685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY LYNN MUSSMAN DC

Provider Business Mailing Address
First Line	:	4633 N MACARTHUR BLVD
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73122-5009
Country	:	US
Telephone Number	:	405-848-3397
Fax Number	:	405-603-3772

Provider Business Practice Location Address
First Line	:	4633 N MACARTHUR BLVD
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73122-5009
Country	:	US
Telephone Number	:	405-848-3397
Fax Number	:	405-603-3772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	12/03/2014

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