Provider Demographics
NPI:1710136312
Name:BAIR, WADE E (DC)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:E
Last Name:BAIR
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 1:1405 W. 12TH AVE.
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074
Mailing Address - Country:US
Mailing Address - Phone:405-533-1511
Mailing Address - Fax:405-533-1161
Practice Address - Street 1:1405 W. 12TH AVE.
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074
Practice Address - Country:US
Practice Address - Phone:405-533-1511
Practice Address - Fax:405-533-1161
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor