Healthcare Provider Details

I. General information

NPI: 1346536901
Provider Name (Legal Business Name): LEPIEN WELLNESS CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 S BROADWAY ST
MARLOW OK
73055-3864
US

IV. Provider business mailing address

1202 S BROADWAY ST
MARLOW OK
73055-3864
US

V. Phone/Fax

Practice location:
  • Phone: 580-658-1042
  • Fax: 580-658-1042
Mailing address:
  • Phone: 580-658-1042
  • Fax: 580-658-1042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4005
License Number StateOK

VIII. Authorized Official

Name: MRS. NANCY LEPIEN
Title or Position: OWNER/OPERATOR
Credential:
Phone: 580-658-1042