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General NPI Number Information
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NPI Number | 1922358779
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Entity Type | Organization
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Legal Business Name | WILBANKS CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 3820 E 51ST ST STE A
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City | TULSA
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State | OK
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Zip | 74135-3610
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Country | US
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Telephone | 918-747-0939
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Fax | 918-747-3939
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Provider Business Mailing Address
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Address Line | 3820 E 51ST ST STE A
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City | TULSA
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State | OK
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Zip | 74135-3610
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Country | US
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Telephone | 918-747-0939
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Fax | 918-747-3939
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | BRANDON EARL WILBANKS
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Credential | D.C.
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Telephone | 918-747-0939
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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 | 4035
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License Number State | OK
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