Organization Active NPI

Wilburton Family Chiropractic

  • Chiropractor
  • Wilburton, OK
National Provider Identifier
1114050374
Registry record updated Feb 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3113 Issued in OK
Legal business name
WILBURTON FAMILY CHIROPRACTIC
Practice address
208 W Main St
Wilburton, OK 74578-4046
Phone
(918) 465-5661
NPI assigned
Mar 14, 2007
Last updated
Feb 16, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Richard E Ingram, D.C.NPI 1801972476
Title
Owner
Phone
(918) 465-5661

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3113 OK Primary

Addresses

Primary practice location

208 W Main St
Wilburton, OK 74578-4046

Mailing address

208 W Main St
Wilburton, OK 74578-4046
Phone (918) 465-5661

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090205000138 OK Part B Supplier - Clinic/Group Practice 3274697271 Receives reassigned benefits from 1 practitioner
Practice locations: Wilburton, OK

National Provider Directory

National Provider Directory

Locations

208 W Main St
Wilburton, OK 74578
Phone (918) 465-5661

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234742400000",
    "number": "1114050374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 W MAIN ST",
            "city": "WILBURTON",
            "state": "OK",
            "postal_code": "745784046",
            "telephone_number": "918-465-5661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 W MAIN ST",
            "city": "WILBURTON",
            "state": "OK",
            "postal_code": "745784046",
            "telephone_number": "918-465-5661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILBURTON FAMILY CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2009-02-16",
        "status": "A",
        "authorized_official_last_name": "INGRAM",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-465-5661",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OK",
            "license": "3113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilburton, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.