Provider Demographics
NPI:1154503639
Name:FAMILY WELLNESS CHIROPRACTIC PC
Entity Type:Organization
Organization Name:FAMILY WELLNESS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VESTAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-577-6268
Mailing Address - Street 1:1809 COMMONS CIR
Mailing Address - Street 2:A
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099
Mailing Address - Country:US
Mailing Address - Phone:405-577-6268
Mailing Address - Fax:405-577-6371
Practice Address - Street 1:1809 COMMONS CIR
Practice Address - Street 2:A
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099
Practice Address - Country:US
Practice Address - Phone:405-577-6268
Practice Address - Fax:405-577-6371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty