Provider Demographics
NPI:1952570491
Name:VARDEMAN, BARRY KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:KEITH
Last Name:VARDEMAN
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 1:1809 N LYNN RIGGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3085
Mailing Address - Country:US
Mailing Address - Phone:918-341-3324
Mailing Address - Fax:918-341-3343
Practice Address - Street 1:1809 N LYNN RIGGS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3085
Practice Address - Country:US
Practice Address - Phone:918-341-3324
Practice Address - Fax:918-341-3343
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor