Provider Demographics
NPI:1104197540
Name:CARDER, LACEY RANAY (DC)
Entity Type:Individual
Prefix:DR
First Name:LACEY
Middle Name:RANAY
Last Name:CARDER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 S. ROCK ISLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-4757
Mailing Address - Country:US
Mailing Address - Phone:405-262-0548
Mailing Address - Fax:
Practice Address - Street 1:1008 S ROCK ISLAND AVE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-4757
Practice Address - Country:US
Practice Address - Phone:405-262-0548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor