Healthcare Provider Details

I. General information

NPI: 1649465022
Provider Name (Legal Business Name): WEDMAN CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W MAIN ST STE P
JENKS OK
74037-3553
US

IV. Provider business mailing address

715 W MAIN ST STE P
JENKS OK
74037-3553
US

V. Phone/Fax

Practice location:
  • Phone: 918-299-8338
  • Fax: 918-299-8336
Mailing address:
  • Phone: 918-299-8338
  • Fax: 918-299-8336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number3307
License Number StateOK

VIII. Authorized Official

Name: JOSHUA MARK WEDMAN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 918-299-8338