Provider Demographics
NPI:1699766162
Name:STATES, TAMRA DIAN (DC)
Entity type:Individual
Prefix:DR
First Name:TAMRA
Middle Name:DIAN
Last Name:STATES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TAMRA
Other - Middle Name:DIAN
Other - Last Name:ALLSUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1614 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-4600
Mailing Address - Country:US
Mailing Address - Phone:405-375-6556
Mailing Address - Fax:405-375-6501
Practice Address - Street 1:1614 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-4600
Practice Address - Country:US
Practice Address - Phone:405-375-6556
Practice Address - Fax:405-375-6501
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU43101Medicare UPIN