Healthcare Provider Details

I. General information

NPI: 1386005858
Provider Name (Legal Business Name): OKC WELLNESS CLINICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825 S. WESTERN AVE
OKLAHOMA CITY OK
73139-1801
US

IV. Provider business mailing address

6825 S. WESTERN AVE
OKLAHOMA CITY OK
73139-1801
US

V. Phone/Fax

Practice location:
  • Phone: 405-609-6600
  • Fax: 405-634-1177
Mailing address:
  • Phone: 405-609-6600
  • Fax: 405-634-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateOK

VIII. Authorized Official

Name: DR. CLAYTON KEITH MUSE
Title or Position: PARTNER
Credential: D.C.
Phone: 405-634-1127