Provider Demographics
NPI:1326341363
Name:EASTERN OKLAHOMA WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:EASTERN OKLAHOMA WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BEELER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-615-3433
Mailing Address - Street 1:6117 S MINGO RD STE C
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6313
Mailing Address - Country:US
Mailing Address - Phone:918-615-3433
Mailing Address - Fax:918-615-3453
Practice Address - Street 1:6117 S MINGO RD STE C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6313
Practice Address - Country:US
Practice Address - Phone:918-615-3433
Practice Address - Fax:918-615-3453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty