MEDICARE: SOWING WELLNESS BUSINESS SOLUTIONS 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	111N00000X	Chiropractor	3778	OK

General Provider Information

NPI Number	:	1356656904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOWING WELLNESS BUSINESS SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	PO BOX 1125
Second Line	:
City	:	JENKS
State	:	OK
Zip	:	74037-1125
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4860 S YALE AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-7007
Country	:	US
Telephone Number	:	918-895-8899
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	AMANDA SIMPSON
Credential	:
Telephone Number	:	918-895-8899

Provider Enumeration Date	:	08/06/2010
Last Update Date	:	08/06/2010

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