Doctor Name: | JAKE WESLEY LANDRETH |
NPI Number: | 1902106768 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | 4002 |
Business Practice Address: | 12707 E 86th St N Owasso, OK - 740552506 |
Business Phone Number: | 9182727432 |
Business Fax Number: | 9182727448 |
Mailing Address: | 12707 E 86th St N, OWASSO |
State: | OK |
Postal Code: | 740552506 |
Phone Number: | 9182727432 |
Fax Number: | 9182727448 |
NPI Enumeration Date: | 10/27/2010 |
NPI Last Update Date: | 10/27/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | 4002 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |