Provider Demographics
NPI:1083259204
Name:HARRAH FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:HARRAH FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:KINCAID
Authorized Official - Last Name:HADERER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-250-1984
Mailing Address - Street 1:19857 NE 23RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-9307
Mailing Address - Country:US
Mailing Address - Phone:405-250-1984
Mailing Address - Fax:
Practice Address - Street 1:19857 NE 23RD ST STE A
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-9307
Practice Address - Country:US
Practice Address - Phone:405-250-1984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty