Organization
GREEN COUNTRY CHIROPRACTIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEO HENRY WYNN D.O. (PRESIDENT)
(918) 473-1182
Entity
Organization
Contact information
Practice address
103 SW 4TH ST, CHECOTAH, OK 74426-3609
(918) 473-1182
(918) 473-2569
Mailing address
103 SW 4TH ST, CHECOTAH, OK 74426-3609
(918) 473-1182
(918) 473-2569
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
20070862
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
731242530-601
BLUE CROSS BLUE SHIELD
OK
05
—
V4403447501
—
OK
Enumeration date
09/19/2007
Last updated
09/19/2007
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