Provider Demographics
NPI:1346641248
Name:DISCOVER CHIROPRACTIC FAMILY AND WELLNESS LLC
Entity Type:Organization
Organization Name:DISCOVER CHIROPRACTIC FAMILY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-659-3752
Mailing Address - Street 1:1401 S DOUGLAS BLVD STE W
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5200
Mailing Address - Country:US
Mailing Address - Phone:405-733-3955
Mailing Address - Fax:
Practice Address - Street 1:516 2ND ST NW
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-8013
Practice Address - Country:US
Practice Address - Phone:405-659-3752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty