Provider Demographics
NPI:1942678115
Name:DWYER, KEARA (DC)
Entity Type:Individual
Prefix:DR
First Name:KEARA
Middle Name:
Last Name:DWYER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KEARA
Other - Middle Name:
Other - Last Name:CAVITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:11560 N 135TH EAST AVE STE 101A
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-5756
Mailing Address - Country:US
Mailing Address - Phone:918-553-6770
Mailing Address - Fax:
Practice Address - Street 1:11560 N 135TH EAST AVE STE 101A
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-5756
Practice Address - Country:US
Practice Address - Phone:918-553-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor