Provider Demographics
NPI:1891914925
Name:HASTY, THEODORE D (DC)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:D
Last Name:HASTY
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 1:810 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-5210
Mailing Address - Country:US
Mailing Address - Phone:580-366-3996
Mailing Address - Fax:580-225-5386
Practice Address - Street 1:810 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5210
Practice Address - Country:US
Practice Address - Phone:580-366-3996
Practice Address - Fax:580-255-5386
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor