Provider Demographics
NPI:1184751224
Name:CARDER CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:CARDER CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:CARDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-262-0548
Mailing Address - Street 1:1008 S ROCK ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-4757
Mailing Address - Country:US
Mailing Address - Phone:405-262-0548
Mailing Address - Fax:405-262-5232
Practice Address - Street 1:1008 S ROCK ISLAND AVE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-4757
Practice Address - Country:US
Practice Address - Phone:405-262-0548
Practice Address - Fax:405-262-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty