Provider Demographics
NPI:1316650518
Name:OAKLEY, TRYSTAN LEE (DC)
Entity type:Individual
Prefix:DR
First Name:TRYSTAN
Middle Name:LEE
Last Name:OAKLEY
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 1:2911 FALCON RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-2000
Mailing Address - Country:US
Mailing Address - Phone:901-626-5884
Mailing Address - Fax:
Practice Address - Street 1:2901 E ZION RD STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5070
Practice Address - Country:US
Practice Address - Phone:479-777-2733
Practice Address - Fax:501-421-9338
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor