Provider Demographics
NPI:1033257993
Name:DWYER CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:DWYER CHIROPRACTIC CLINIC PC
Other - Org Name:DWYER CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-733-3955
Mailing Address - Street 1:1401 S DOUGLAS BLVD
Mailing Address - Street 2:STE W
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5200
Mailing Address - Country:US
Mailing Address - Phone:405-733-3955
Mailing Address - Fax:405-733-4014
Practice Address - Street 1:1401 S DOUGLAS BLVD
Practice Address - Street 2:STE W
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5200
Practice Address - Country:US
Practice Address - Phone:405-733-3955
Practice Address - Fax:405-733-4014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
OK3647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3647OtherSTATE LIC NUMBER
OK247302202Medicare PIN
OK3647OtherSTATE LIC NUMBER