Healthcare Provider Details

I. General information

NPI: 1912147257
Provider Name (Legal Business Name): DEBORAH ANN KUCHARSKI D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7385 E RIDGEVIEW WAY
CLAREMORE OK
74019-2394
US

IV. Provider business mailing address

7385 E RIDGEVIEW WAY
CLAREMORE OK
74019-2394
US

V. Phone/Fax

Practice location:
  • Phone: 661-309-2259
  • Fax: 918-379-0803
Mailing address:
  • Phone: 661-309-2259
  • Fax: 918-379-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number3332
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: