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General NPI Number Information
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NPI Number | 1093311995
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Entity Type | Organization
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Legal Business Name | AWAKEN HEALTH AND WELLNESS CENTER
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Dates
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Enumeration Date | 12/07/2020
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 3409 S BROADWAY STE 801
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City | EDMOND
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State | OK
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Zip | 73013-4129
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Country | US
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Telephone | 405-515-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 157 STONEBRIDGE BLVD APT 2232
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City | EDMOND
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State | OK
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Zip | 73013-4775
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JARED LANE
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Credential |
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Telephone | 903-724-5505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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