Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4409 | OK |
NPI | 1003471996 |
---|---|
Provider Name | Cory Wilsey |
First Address | Claremore, OK 74017-8431 |
Second Address | Claremore, OK 74017-8431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2019 |
Last Update Date | 30/08/2021 |