Healthcare Provider Details

I. General information

NPI: 1003990185
Provider Name (Legal Business Name): OKEMAH CHIROPRACTIC CLINIC INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 W BROADWAY
OKEMAH OK
74859
US

IV. Provider business mailing address

1003 W BROADWAY
OKEMAH OK
74859
US

V. Phone/Fax

Practice location:
  • Phone: 918-623-0613
  • Fax: 918-623-0613
Mailing address:
  • Phone: 918-623-0613
  • Fax: 918-623-0613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3578
License Number StateOK

VIII. Authorized Official

Name: MR. BRETT ALAN WESSEL
Title or Position: CHIROPRACTOR PRESIDENT
Credential: DC
Phone: 918-623-0613