MEDICARE: NATIVE CHIROPRACTIC LLC

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	111NP0017X	Pediatric Chiropractor
2	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4401	OTHER	OK	OKLAHOMA BOARD OF CHIROPRACTORS

General Provider Information

NPI Number	:	1104531680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIVE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	2237 W MEMORIAL RD STE 116
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-8064
Country	:	US
Telephone Number	:	405-534-4244
Fax Number	:	405-543-1131

Provider Business Practice Location Address
First Line	:	2237 W MEMORIAL RD STE 116
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-8064
Country	:	US
Telephone Number	:	405-534-4244
Fax Number	:	405-543-1131

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC/ OWNER
Name	:	DR. BRITTANY WETZEL
Credential	:	DC
Telephone Number	:	405-534-4244

Provider Enumeration Date	:	01/18/2023
Last Update Date	:	01/18/2023

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