Provider Demographics
NPI:1992814669
Name:VAN WYHE, HEATHER ANN (DC)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ANN
Last Name:VAN WYHE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 N 145TH E AVE STE 103-104
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055
Mailing Address - Country:US
Mailing Address - Phone:918-274-9299
Mailing Address - Fax:918-274-9220
Practice Address - Street 1:8805 N 145TH E AVE STE 103-104
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055
Practice Address - Country:US
Practice Address - Phone:918-274-9299
Practice Address - Fax:918-274-9220
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U96936Medicare UPIN