Provider Demographics
NPI:1427078278
Name:DUQUE, ERMILO S (BS, DC, FASA)
Entity type:Individual
Prefix:DR
First Name:ERMILO
Middle Name:S
Last Name:DUQUE
Suffix:
Gender:M
Credentials:BS, DC, FASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3604
Mailing Address - Country:US
Mailing Address - Phone:405-513-5894
Mailing Address - Fax:
Practice Address - Street 1:165 W 15TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3604
Practice Address - Country:US
Practice Address - Phone:405-513-5894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor