Organization
COUNTRYSIDE WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY J CALLAWAY DC (OWNER/CHIROPRACTOR)
(918) 708-2563
Entity
Organization
Contact information
Practice address
2067 MAHANEY AVE, TAHLEQUAH, OK 74464-5731
(918) 708-2563
Mailing address
2067 MAHANEY AVE, TAHLEQUAH, OK 74464-5731
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
08/23/2010
Last updated
09/05/2024
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