Individual provider Active NPI

Eugene E Bledsoe, D.C.

  • Chiropractor
  • Bristow, OK
National Provider Identifier
1710056403
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3360 Issued in OK
Practice address
116 W 8TH Ave
Bristow, OK 74010-2412
Phone
(918) 367-9600
Fax
(918) 367-9699
NPI assigned
Nov 7, 2006
Sex
Male
Sole proprietor
Yes

Medicare Care Compare profile

Specialty
Chiropractic
Education
Cleveland Chiropractic College - Kansas City, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

509 N Main St
Bristow, OK 74010-2016
Phone (918) 367-9600

Medicare participation

Medicare fee-for-service enrollment
Enrolled in OK

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20080509000258 OK Practitioner - Chiropractic 8022197458 Practice locations: Bristow, OK

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
3360OKMDInternal Medicine Physician

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3360 OK Primary

Addresses

NPPES NPI Registry

Primary practice location

116 W 8TH Ave
Bristow, OK 74010-2412

Mailing address

116 W 8TH Ave
Bristow, OK 74010-2412
Phone (918) 367-9600

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710056403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 W 8TH AVE",
            "city": "BRISTOW",
            "state": "OK",
            "postal_code": "740102412",
            "telephone_number": "918-367-9600",
            "fax_number": "918-367-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 W 8TH AVE",
            "city": "BRISTOW",
            "state": "OK",
            "postal_code": "740102412",
            "telephone_number": "918-367-9600",
            "fax_number": "918-367-9699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEDSOE",
        "first_name": "EUGENE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "3360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.