Healthcare Provider Details

I. General information

NPI: 1699141887
Provider Name (Legal Business Name): CASEY S OKAMOTO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 N PEARL ST APT 42
BUFFALO NY
14202-1416
US

IV. Provider business mailing address

44 N PEARL ST APT 42
BUFFALO NY
14202-1416
US

V. Phone/Fax

Practice location:
  • Phone: 608-320-9104
  • Fax:
Mailing address:
  • Phone: 608-320-9104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number077861
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: