MEDICARE: TOTAL HEALTH & WELLNESS CENTER INC

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	DC3543	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	467277639001	OTHER	OK	BLUE CROSS BLUE SHIELD
2	790814	OTHER	OK	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770666752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL HEALTH & WELLNESS CENTER INC

Provider Business Mailing Address
First Line	:	1259 N WASHINGTON AVE
Second Line	:
City	:	DURANT
State	:	OK
Zip	:	74701-2119
Country	:	US
Telephone Number	:	580-920-2555
Fax Number	:	580-920-2666

Provider Business Practice Location Address
First Line	:	1259 N WASHINGTON AVE
Second Line	:
City	:	DURANT
State	:	OK
Zip	:	74701-2119
Country	:	US
Telephone Number	:	580-920-2555
Fax Number	:	580-920-2666

Authorized Official
Title or Position	:	DOCTOR/ OWNER
Name	:	DR. JEFFREY LYNN COTTINGAME
Credential	:	D.C.
Telephone Number	:	580-920-2555

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/16/2013

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