Healthcare Provider Details

I. General information

NPI: 1497947832
Provider Name (Legal Business Name): HEALTH & WELLNESS CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 E 91ST ST
TULSA OK
74137-2804
US

IV. Provider business mailing address

4755 E 91ST ST
TULSA OK
74137-2804
US

V. Phone/Fax

Practice location:
  • Phone: 918-488-0444
  • Fax:
Mailing address:
  • Phone: 918-488-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number20070685
License Number StateOK

VIII. Authorized Official

Name: JOEL R ROBBINS
Title or Position: DOCTOR
Credential: D.C.
Phone: 918-488-0444