MEDICARE: DR. RAYMOND P MARSHALL D.C.

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	3300	OK

General Provider Information

NPI Number	:	1750432274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND P MARSHALL D.C.

Provider Business Mailing Address
First Line	:	6931 S 66TH EAST AVE
Second Line	:	SUITE 200
City	:	TULSA
State	:	OK
Zip	:	74133-1754
Country	:	US
Telephone Number	:	918-523-0111
Fax Number	:	918-523-0312

Provider Business Practice Location Address
First Line	:	6931 S 66TH EAST AVE
Second Line	:	SUITE 200
City	:	TULSA
State	:	OK
Zip	:	74133-1754
Country	:	US
Telephone Number	:	918-523-0111
Fax Number	:	918-523-0312

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	04/20/2008

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