Provider Demographics
NPI:1295742435
Name:TATUM, TERRY R (DC)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:R
Last Name:TATUM
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 1:3315 E 47TH PL # 120
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2914
Mailing Address - Country:US
Mailing Address - Phone:918-622-9655
Mailing Address - Fax:918-622-9657
Practice Address - Street 1:3315 E 47TH PL # 120
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2914
Practice Address - Country:US
Practice Address - Phone:918-622-9655
Practice Address - Fax:918-622-9657
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKY00825Medicare UPIN
OK242403500Medicare PIN