Individual
DR. TIMOTHY R BLANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
101 E BROADWAY AVE, PONCA CITY, OK 74601-4302
(580) 765-2482
(580) 765-4852
Mailing address
101 E BROADWAY AVE, PONCA CITY, OK 74601-4302
(580) 765-2482
(580) 765-4852
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3102
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00288810
RAILROAD MEDICARE
OK
Enumeration date
11/01/2006
Last updated
07/08/2007
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