Provider Demographics
NPI:1386005858
Name:OKC WELLNESS CLINICS, LLC
Entity Type:Organization
Organization Name:OKC WELLNESS CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-634-1127
Mailing Address - Street 1:6825 S. WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-1801
Mailing Address - Country:US
Mailing Address - Phone:405-609-6600
Mailing Address - Fax:405-634-1177
Practice Address - Street 1:6825 S. WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1801
Practice Address - Country:US
Practice Address - Phone:405-609-6600
Practice Address - Fax:405-634-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK111N00000X, 207XX0801X, 208D00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty