Provider Demographics
NPI:1487925475
Name:OGLE, TABITHA LYNN (DC)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:LYNN
Last Name:OGLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:103 ICHORD AVE
Mailing Address - Street 2:STE B
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-5402
Mailing Address - Country:US
Mailing Address - Phone:417-532-2986
Mailing Address - Fax:417-532-2271
Practice Address - Street 1:617 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-2745
Practice Address - Country:US
Practice Address - Phone:417-532-2986
Practice Address - Fax:417-532-2271
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012001172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor