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NPI Code Detail

MEDICARE: DR. CORD TANNER LANDRUM D.C., PA-C

MEDICARE: DR. CORD TANNER LANDRUM D.C., PA-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
1111N00000XChiropractor3744OK
2363A00000XPhysician Assistant3003OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13003OTHEROKOKLAHOMA BOARD OF MEDICAL LICENSURE

General Provider Information

NPI Number : 1801986740
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CORD TANNER LANDRUM D.C., PA-C
Provider Business Mailing Address
First Line : 527 W 3RD ST
Second Line :
City : KONAWA
State : OK
Zip : 74849-1415
Country : US
Telephone Number : 580-925-3286
Fax Number : 580-925-9149
Provider Business Practice Location Address
First Line : 905 COLONY DR
Second Line :
City : ADA
State : OK
Zip : 74820-2329
Country : US
Telephone Number : 580-436-5111
Fax Number : 580-436-1159
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 11/22/2021

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Directions to “ DR. CORD TANNER LANDRUM D.C., PA-C” Practice Location

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