MEDICARE: TEXOMA CHIROPRACTIC AND WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1922709807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXOMA CHIROPRACTIC AND WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	1259 N WASHINGTON AVE
Second Line	:
City	:	DURANT
State	:	OK
Zip	:	74701-2119
Country	:	US
Telephone Number	:	580-920-2555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1259 N WASHINGTON AVE
Second Line	:
City	:	DURANT
State	:	OK
Zip	:	74701-2119
Country	:	US
Telephone Number	:	580-920-2555
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. DALTON BROWN
Credential	:	DC
Telephone Number	:	918-413-3979

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	03/16/2023

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