Provider Demographics
NPI:1649457110
Name:ASH LAKE WELLNESS, INC.
Entity type:Organization
Organization Name:ASH LAKE WELLNESS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CALE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-938-6801
Mailing Address - Street 1:3701 S HARVARD AVE STE D
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2282
Mailing Address - Country:US
Mailing Address - Phone:918-938-6801
Mailing Address - Fax:918-938-6802
Practice Address - Street 1:3701 S HARVARD AVE STE D
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2282
Practice Address - Country:US
Practice Address - Phone:918-938-6801
Practice Address - Fax:918-938-6802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty