Provider Demographics
NPI:1508891631
Name:WEEMS, JACK BENSON (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:BENSON
Last Name:WEEMS
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 1:467 SOUTH WILSON
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-4245
Mailing Address - Country:US
Mailing Address - Phone:918-256-8744
Mailing Address - Fax:918-256-8747
Practice Address - Street 1:467 SOUTH WILSON
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-4245
Practice Address - Country:US
Practice Address - Phone:918-256-8744
Practice Address - Fax:918-256-8747
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor