MEDICARE: CHIROPRACTIC WELLNESS CLINIC 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	3248	OK
2	111N00000X	Chiropractor	3379	OK

General Provider Information

NPI Number	:	1548335441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC WELLNESS CLINIC PC

Provider Business Mailing Address
First Line	:	12401 N MAY AVE
Second Line	:	SUITE 103
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-1967
Country	:	US
Telephone Number	:	405-842-3413
Fax Number	:	405-842-3417

Provider Business Practice Location Address
First Line	:	12401 N MAY AVE
Second Line	:	SUITE 103
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-1967
Country	:	US
Telephone Number	:	405-842-3413
Fax Number	:	405-842-3417

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ASHLEIGH R MUSE
Credential	:	D.C.
Telephone Number	:	405-842-3413

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	08/22/2020

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