Healthcare Provider Details

I. General information

NPI: 1922358779
Provider Name (Legal Business Name): WILBANKS CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 E 51ST ST STE A
TULSA OK
74135-3610
US

IV. Provider business mailing address

3820 E 51ST ST STE A
TULSA OK
74135-3610
US

V. Phone/Fax

Practice location:
  • Phone: 918-747-0939
  • Fax: 918-747-3939
Mailing address:
  • Phone: 918-747-0939
  • Fax: 918-747-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4035
License Number StateOK

VIII. Authorized Official

Name: BRANDON EARL WILBANKS
Title or Position: DOCTOR/OWNER
Credential: D.C.
Phone: 918-747-0939