Provider Demographics
NPI:1205960754
Name:HEALTH WISE CHIROPRACTIC INC PC
Entity type:Organization
Organization Name:HEALTH WISE CHIROPRACTIC INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MONTESANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-461-9490
Mailing Address - Street 1:9104 E 62ND ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6443
Mailing Address - Country:US
Mailing Address - Phone:918-461-9490
Mailing Address - Fax:918-461-9690
Practice Address - Street 1:9104 E 62ND ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6443
Practice Address - Country:US
Practice Address - Phone:918-461-9490
Practice Address - Fax:918-461-9690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK700522007Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER