Provider Demographics
NPI:1174632525
Name:VALLANDINGHAM, ROBERT THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THOMAS
Last Name:VALLANDINGHAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-4415
Mailing Address - Country:US
Mailing Address - Phone:580-622-5959
Mailing Address - Fax:580-622-6108
Practice Address - Street 1:1205 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4415
Practice Address - Country:US
Practice Address - Phone:580-622-5959
Practice Address - Fax:580-622-6108
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200040180 AMedicaid
OKU99064Medicare UPIN
OK244412801Medicare ID - Type Unspecified