Provider Demographics
NPI:1194703454
Name:HUSKEY, FREDRICK JOHN (DC)
Entity type:Individual
Prefix:
First Name:FREDRICK
Middle Name:JOHN
Last Name:HUSKEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:FREDRICK
Other - Middle Name:JOHN
Other - Last Name:HUSKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3820 E. 51 ST
Mailing Address - Street 2:STE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135
Mailing Address - Country:US
Mailing Address - Phone:918-747-0939
Mailing Address - Fax:918-747-3939
Practice Address - Street 1:3820 E. 51 ST
Practice Address - Street 2:STE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-747-0939
Practice Address - Fax:918-747-3939
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3054111N00000X, 111NR0200X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
T79957Medicare UPIN