Provider Demographics
NPI:1811047046
Name:WEDMAN, JOSHUA M (DC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:M
Last Name:WEDMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:715 W MAIN ST STE P
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-3553
Mailing Address - Country:US
Mailing Address - Phone:918-299-8338
Mailing Address - Fax:918-299-8336
Practice Address - Street 1:715 W MAIN ST STE P
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3553
Practice Address - Country:US
Practice Address - Phone:918-299-8338
Practice Address - Fax:918-299-8336
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK241425403Medicare UPIN