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General NPI Number Information
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NPI Number | 1992926828
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Entity Type | Organization
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Legal Business Name | WILLEMSTEIN ENTERPRISES, INC
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 10/31/2012
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Provider Practice Location Address
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Address Line | 2303 S MEMORIAL DR
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City | TULSA
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State | OK
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Zip | 74129-2615
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Country | US
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Telephone | 918-622-9533
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Fax | 918-622-9533
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Provider Business Mailing Address
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Address Line | 2303 S MEMORIAL DR
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City | TULSA
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State | OK
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Zip | 74129-2615
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Country | US
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Telephone | 918-622-9533
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Fax | 918-622-9536
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LECRAIG JOHN WILLEMSTEIN
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Credential | D.C.
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Telephone | 918-622-9533
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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 | 2393
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License Number State | OK
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