Provider Demographics
NPI:1154683423
Name:PRINCE CHIROPRACTIC WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:PRINCE CHIROPRACTIC WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-757-2079
Mailing Address - Street 1:13501 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73131-1824
Mailing Address - Country:US
Mailing Address - Phone:405-757-2079
Mailing Address - Fax:405-493-0713
Practice Address - Street 1:13501 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73131-1824
Practice Address - Country:US
Practice Address - Phone:405-757-2079
Practice Address - Fax:405-493-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty