Provider Demographics
NPI:1447709589
Name:LIM, JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:LIM
Suffix:
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 1:3601 S BROADWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4116
Mailing Address - Country:US
Mailing Address - Phone:405-753-9355
Mailing Address - Fax:405-753-9478
Practice Address - Street 1:3601 S BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4116
Practice Address - Country:US
Practice Address - Phone:405-753-9355
Practice Address - Fax:405-753-9478
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor