Provider Demographics
NPI:1982804605
Name:WADE, ROBERT BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRIAN
Last Name:WADE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 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
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor