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General NPI Number Information
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NPI Number | 1770666752
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTH & WELLNESS CENTER INC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 1259 N WASHINGTON AVE
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City | DURANT
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State | OK
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Zip | 74701-2119
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Country | US
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Telephone | 580-920-2555
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Fax | 580-920-2666
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Provider Business Mailing Address
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Address Line | 1259 N WASHINGTON AVE
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City | DURANT
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State | OK
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Zip | 74701-2119
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Country | US
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Telephone | 580-920-2555
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Fax | 580-920-2666
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Authorized Official
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Title or Position | DOCTOR/ OWNER
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Name | DR. JEFFREY LYNN COTTINGAME
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Credential | D.C.
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Telephone | 580-920-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC3543
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License Number State | OK
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