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DR. TIMOTHY R BLANTON DC

>> Chiropractor >> Chiropractic Providers

Registrant NPI Number: 1821175076

Individual Registrant:
DR. TIMOTHY R BLANTON DC
Gender: M
Not Sole Proprietor

Location and contact information for practice:
101 E BROADWAY AVE  PONCA CITY, OK 74601-4302 US
Tel: 580-765-2482  Fax: 580-765-4852

Contact information for business:
101 E BROADWAY AVE  PONCA CITY, OK 74601-4302 US
Tel: 580-765-2482  Fax: 580-765-4852

Registration Information:
NPI: 1821175076
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y111N00000XChiropractic Providers
Chiropractor
OK3102

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
RAILROAD MEDICAREP00288810OK01




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