Provider Demographics
NPI:1225014558
Name:STRAIT, W T
Entity Type:Individual
Prefix:DR
First Name:W
Middle Name:T
Last Name:STRAIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3141
Mailing Address - Country:US
Mailing Address - Phone:405-214-2226
Mailing Address - Fax:405-214-2232
Practice Address - Street 1:2022 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-3141
Practice Address - Country:US
Practice Address - Phone:405-214-2226
Practice Address - Fax:405-214-2232
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKBC/BS731116025-002OtherMAJOR MEDICAL
OKQDBSXMedicare ID - Type Unspecified
OKT75142Medicare UPIN