MEDICARE: SILVERLAKE HEALTH AND WELLNESS CENTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2474	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	444546930003	OTHER	OK	BCBS
2	5129060	OTHER	OK	AETNA

General Provider Information

NPI Number	:	1033294343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVERLAKE HEALTH AND WELLNESS CENTER PC

Provider Business Mailing Address
First Line	:	2401 NOWATA PL
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-4753
Country	:	US
Telephone Number	:	918-331-5390
Fax Number	:	918-331-5347

Provider Business Practice Location Address
First Line	:	2401 NOWATA PL
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-4753
Country	:	US
Telephone Number	:	918-331-5390
Fax Number	:	918-331-5347

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KAREN FAYE WALLIS
Credential	:	DC
Telephone Number	:	918-331-5390

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/22/2020

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Directions to “SILVERLAKE HEALTH AND WELLNESS CENTER PC ” Practice Location

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