Healthcare Provider Details

I. General information

NPI: 1689661191
Provider Name (Legal Business Name): CHRISTOPHER CARLUS KASTNER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 N MARKET ST
CORDELL OK
73632-2431
US

IV. Provider business mailing address

1206 N MARKET ST
CORDELL OK
73632-2431
US

V. Phone/Fax

Practice location:
  • Phone: 580-832-3829
  • Fax: 580-832-5118
Mailing address:
  • Phone: 580-832-3829
  • Fax: 580-832-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2189
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: