Provider Demographics
NPI:1982878781
Name:FAVORITE, MARCUS BRADLEY (DC)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:BRADLEY
Last Name:FAVORITE
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 1:14101 N MAY AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-5071
Mailing Address - Country:US
Mailing Address - Phone:405-753-9793
Mailing Address - Fax:
Practice Address - Street 1:13205 GREEN HILL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8875
Practice Address - Country:US
Practice Address - Phone:405-753-9793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor