Provider Demographics
NPI:1437130390
Name:HAMMERSTROM, ROGER L (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:L
Last Name:HAMMERSTROM
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 1:1123 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3121
Mailing Address - Country:US
Mailing Address - Phone:580-256-5314
Mailing Address - Fax:580-256-5314
Practice Address - Street 1:1123 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3121
Practice Address - Country:US
Practice Address - Phone:580-256-5314
Practice Address - Fax:580-256-5314
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T75418Medicare UPIN
300522139Medicare ID - Type Unspecified