Healthcare Provider Details

I. General information

NPI: 1205960754
Provider Name (Legal Business Name): HEALTH WISE CHIROPRACTIC INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9104 E 62ND ST
TULSA OK
74133-6443
US

IV. Provider business mailing address

9104 E 62ND ST
TULSA OK
74133-6443
US

V. Phone/Fax

Practice location:
  • Phone: 918-461-9490
  • Fax: 918-461-9690
Mailing address:
  • Phone: 918-461-9490
  • Fax: 918-461-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3517
License Number StateOK

VIII. Authorized Official

Name: DR. JESSICA LYNN MONTESANO
Title or Position: PRESIDENT
Credential: DC
Phone: 918-461-9490