Provider Demographics
NPI:1992907257
Name:DR. RONALD B. TRIPP, CHIROPRACTIC PHYSICIAN, INC
Entity type:Organization
Organization Name:DR. RONALD B. TRIPP, CHIROPRACTIC PHYSICIAN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:405-321-8530
Mailing Address - Street 1:2400 TEE CIR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6378
Mailing Address - Country:US
Mailing Address - Phone:405-321-8530
Mailing Address - Fax:405-321-1478
Practice Address - Street 1:2400 TEE CIR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6378
Practice Address - Country:US
Practice Address - Phone:405-321-8530
Practice Address - Fax:405-321-1478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371604138004OtherBLUE CROSS BLUE SHIELD
OK5493679OtherAETNA
OKT75213OtherAETNA