Countryside Wellness LLC
NPI 1205142700 · Chiropractor · Tahlequah, OK
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Countryside Wellness LLC is a Chiropractor organization in Tahlequah, OK (NPI 1205142700).
Provider details
- NPI number
- 1205142700
- Entity type
- Organization
- Primary specialty
- ChiropractorChiropractic Providers
- Organization subpart
- No
- Authorized official
- Kelly Callaway, Owner/Chiropractor(918) 708-2563
Specialties & taxonomies
Chiropractic Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
15 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2010-08-23
- Last updated
- 2024-09-05
- Certified
- 2024-09-05
Frequently asked questions
- What is Countryside Wellness LLC's NPI number?
- Countryside Wellness LLC's National Provider Identifier (NPI) is 1205142700, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Countryside Wellness LLC?
- Countryside Wellness LLC is classified in the NPPES registry as Chiropractor (Chiropractic Providers).
- Where is Countryside Wellness LLC located?
- Countryside Wellness LLC's practice location on file with NPPES is 2067 Mahaney Ave, Tahlequah, OK 74464-5731.
- What is Countryside Wellness LLC's phone number?
- The practice phone number listed in the NPPES registry for Countryside Wellness LLC is (918) 708-2563.
- Does Countryside Wellness LLC accept Medicare?
- Countryside Wellness LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Countryside Wellness LLC?
- The authorized official listed on Countryside Wellness LLC's NPPES record is Kelly Callaway, Owner/Chiropractor. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Countryside Wellness LLC's NPI active?
- Yes — Countryside Wellness LLC's NPI (1205142700) is active in the NPPES registry as of the last update on 2024-09-05.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.