Provider Demographics
NPI:1033122585
Name:COFFMAN, DAMON HOLT (DC)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:HOLT
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 739
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-0739
Mailing Address - Country:US
Mailing Address - Phone:405-454-6400
Mailing Address - Fax:
Practice Address - Street 1:1083 N HARRAH RD
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-9692
Practice Address - Country:US
Practice Address - Phone:405-454-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3668111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor