Provider Demographics
NPI:1154561637
Name:PANACEA WELLNESS AND CHIROPRACTIC
Entity type:Organization
Organization Name:PANACEA WELLNESS AND CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WASSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-549-5207
Mailing Address - Street 1:7511 E GALVESTON PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-7053
Mailing Address - Country:US
Mailing Address - Phone:918-549-5207
Mailing Address - Fax:
Practice Address - Street 1:7511 E GALVESTON PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-7053
Practice Address - Country:US
Practice Address - Phone:918-549-5207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty