Provider Demographics
NPI:1578861753
Name:ORTIZ, SHAWNA NICHOLE (DC)
Entity type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:NICHOLE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:SHAWNA
Other - Middle Name:NICHOLE
Other - Last Name:BENIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1132 PROVIDENCE CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-6155
Mailing Address - Country:US
Mailing Address - Phone:918-557-6299
Mailing Address - Fax:
Practice Address - Street 1:6444 NW EXPRESSWAY
Practice Address - Street 2:SUITE 828A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-5131
Practice Address - Country:US
Practice Address - Phone:405-470-6415
Practice Address - Fax:405-470-6417
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor