Provider Demographics
NPI:1346538857
Name:WILBANKS, BRANDON (DC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:WILBANKS
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 1:8205 E REGAL CT
Mailing Address - Street 2:STE 106
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7183
Mailing Address - Country:US
Mailing Address - Phone:918-747-3939
Mailing Address - Fax:
Practice Address - Street 1:3820 E 51ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3627
Practice Address - Country:US
Practice Address - Phone:918-747-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor