Provider Demographics
NPI:1992730378
Name:DEAN, ALAN RUSSELL JR (DC)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RUSSELL
Last Name:DEAN
Suffix:JR
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 1:3200 N O ST
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-6310
Mailing Address - Country:US
Mailing Address - Phone:580-789-0489
Mailing Address - Fax:
Practice Address - Street 1:313 N 4TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-4554
Practice Address - Country:US
Practice Address - Phone:580-765-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK237622701Medicare PIN