Healthcare Provider Details

I. General information

NPI: 1649563958
Provider Name (Legal Business Name): OWASSO WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13720 E 86TH ST N SUITE 130
OWASSO OK
74055-8704
US

IV. Provider business mailing address

13720 E 86TH ST N SUITE 130
OWASSO OK
74055-8704
US

V. Phone/Fax

Practice location:
  • Phone: 918-274-3888
  • Fax:
Mailing address:
  • Phone: 918-274-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3999
License Number StateOK

VIII. Authorized Official

Name: JOEL JOHNSON
Title or Position: OWNER
Credential: D.C.
Phone: 918-274-3888