Provider Demographics
NPI:1992926828
Name:WILLEMSTEIN ENTERPRISES, INC
Entity type:Organization
Organization Name:WILLEMSTEIN ENTERPRISES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LECRAIG
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WILLEMSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-622-9533
Mailing Address - Street 1:2303 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-2615
Mailing Address - Country:US
Mailing Address - Phone:918-622-9533
Mailing Address - Fax:918-622-9536
Practice Address - Street 1:2303 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-2615
Practice Address - Country:US
Practice Address - Phone:918-622-9533
Practice Address - Fax:918-622-9533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty