MEDICARE: DR. CHRISTIAN WINDHAM D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4164	OK

General Provider Information

NPI Number	:	1043611668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIAN WINDHAM D.C.

Provider Business Mailing Address
First Line	:	6020 N ROBINSON AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7426
Country	:	US
Telephone Number	:	405-767-9750
Fax Number	:	405-767-9759

Provider Business Practice Location Address
First Line	:	6020 N ROBINSON AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7426
Country	:	US
Telephone Number	:	405-767-9750
Fax Number	:	405-767-9759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2014
Last Update Date	:	09/15/2014

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