Provider Demographics
NPI:1700102670
Name:OATMAN, ROGER KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:KEITH
Last Name:OATMAN
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 1:904 MCINTOSH CIR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-4740
Mailing Address - Country:US
Mailing Address - Phone:816-331-5951
Mailing Address - Fax:
Practice Address - Street 1:2017 PLAZA DR
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-1264
Practice Address - Country:US
Practice Address - Phone:816-380-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006005530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74-2557028OtherFEDERAL (EMPLOYER) TAX ID #
TX2749Medicare PIN