Provider Demographics
NPI:1831113505
Name:WADE CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:WADE CHIROPRACTIC CLINIC INC
Other - Org Name:WEATHERFORD CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-774-0611
Mailing Address - Street 1:500 N WASHINGTON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-5700
Mailing Address - Country:US
Mailing Address - Phone:580-774-0611
Mailing Address - Fax:580-774-0644
Practice Address - Street 1:500 N WASHINGTON ST STE 3
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5700
Practice Address - Country:US
Practice Address - Phone:580-774-0611
Practice Address - Fax:580-774-0644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WADE CHIROPRACTIC CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK244516701Medicare PIN
OK400522423Medicare ID - Type UnspecifiedGROUP #
OKV01660Medicare UPIN