Provider Demographics
NPI:1548335441
Name:CHIROPRACTIC WELLNESS CLINIC PC
Entity type:Organization
Organization Name:CHIROPRACTIC WELLNESS CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEIGH
Authorized Official - Middle Name:R
Authorized Official - Last Name:MUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-842-3413
Mailing Address - Street 1:12401 N MAY AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1967
Mailing Address - Country:US
Mailing Address - Phone:405-842-3413
Mailing Address - Fax:405-842-3417
Practice Address - Street 1:12401 N MAY AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1967
Practice Address - Country:US
Practice Address - Phone:405-842-3413
Practice Address - Fax:405-842-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3248111N00000X
OK3379111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK71749Medicare UPIN