Provider Demographics
NPI:1568637460
Name:VARDEMAN CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:VARDEMAN CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:VARDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-341-3324
Mailing Address - Street 1:1809 N LYNN RIGGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3085
Mailing Address - Country:US
Mailing Address - Phone:918-341-3324
Mailing Address - Fax:918-341-3343
Practice Address - Street 1:1809 N LYNN RIGGS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3085
Practice Address - Country:US
Practice Address - Phone:918-341-3324
Practice Address - Fax:918-341-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty