Provider Demographics
NPI:1235832387
Name:GOLBEK, DWAYNE (DC)
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:
Last Name:GOLBEK
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 1:23352 S 4150 RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-0601
Mailing Address - Country:US
Mailing Address - Phone:918-899-7764
Mailing Address - Fax:
Practice Address - Street 1:1755 N HIGHWAY 66 STE F
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-2717
Practice Address - Country:US
Practice Address - Phone:918-416-7238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4266111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician