Provider Demographics
NPI:1669852919
Name:WILCOX, BRANDI DAWN (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:DAWN
Last Name:WILCOX
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-7912
Mailing Address - Country:US
Mailing Address - Phone:918-246-5808
Mailing Address - Fax:918-246-5809
Practice Address - Street 1:413 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7912
Practice Address - Country:US
Practice Address - Phone:918-246-5808
Practice Address - Fax:918-246-5809
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor