Provider Demographics
NPI:1215027255
Name:WILLEMSTEIN, LECRAIG JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:LECRAIG
Middle Name:JOHN
Last Name:WILLEMSTEIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-2615
Mailing Address - Country:US
Mailing Address - Phone:918-622-9533
Mailing Address - Fax:918-622-9536
Practice Address - Street 1:2303 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-2615
Practice Address - Country:US
Practice Address - Phone:918-622-9533
Practice Address - Fax:918-622-9536
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2393111N00000X
TX4540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor