Provider Demographics
NPI:1164487229
Name:DUREE, WILLENA (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLENA
Middle Name:
Last Name:DUREE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:WILLA
Other - Middle Name:
Other - Last Name:DUREE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:318 W HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-6738
Mailing Address - Country:US
Mailing Address - Phone:405-275-6363
Mailing Address - Fax:405-275-6338
Practice Address - Street 1:318 W HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6738
Practice Address - Country:US
Practice Address - Phone:405-275-6363
Practice Address - Fax:405-275-6338
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3767111N00000X
CA17279111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC017279Medicare ID - Type Unspecified