Provider Demographics
NPI:1902994981
Name:HERRING, JILL A (DC)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:A
Last Name:HERRING
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:A
Other - Last Name:BEATY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 754
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-0754
Mailing Address - Country:US
Mailing Address - Phone:580-549-6932
Mailing Address - Fax:580-549-6057
Practice Address - Street 1:102 CENTRAL
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:OK
Practice Address - Zip Code:73541
Practice Address - Country:US
Practice Address - Phone:580-549-6932
Practice Address - Fax:580-549-6057
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK48853Medicare UPIN