Individual
CHARLOTTE RAY BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
412 NW 23RD ST, OKLAHOMA CITY, OK 73103-1508
(405) 528-1445
Mailing address
PO BOX 61312, OKLAHOMA CITY, OK 73146-1312
(405) 528-1445
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3173
OK
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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