Healthcare Provider Details

I. General information

NPI: 1730828112
Provider Name (Legal Business Name): PHYSICIANS AT ENID LIVE WELL, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3126 CLAIREMONT
ENID OK
73703-1513
US

IV. Provider business mailing address

3126 CLAIREMONT
ENID OK
73703-1513
US

V. Phone/Fax

Practice location:
  • Phone: 580-233-4300
  • Fax: 580-350-6401
Mailing address:
  • Phone: 580-233-4300
  • Fax: 580-350-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. VIKI SHARLAINE RESLER
Title or Position: CEO
Credential: DC, RN
Phone: 580-233-4300