Provider Demographics
NPI:1689661191
Name:KASTNER, CHRISTOPHER CARLUS (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:CARLUS
Last Name:KASTNER
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 1:1206 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CORDELL
Mailing Address - State:OK
Mailing Address - Zip Code:73632-2431
Mailing Address - Country:US
Mailing Address - Phone:580-832-3829
Mailing Address - Fax:580-832-5118
Practice Address - Street 1:1206 N MARKET ST
Practice Address - Street 2:
Practice Address - City:CORDELL
Practice Address - State:OK
Practice Address - Zip Code:73632-2431
Practice Address - Country:US
Practice Address - Phone:580-832-3829
Practice Address - Fax:580-832-5118
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK73115943301OtherBLUE CROSS BLUE SHIELD
OK731159433OtherTAX ID NUMBER
OKT75219Medicare UPIN
OKB5034Medicare PIN