Healthcare Provider Details

I. General information

NPI: 1528219847
Provider Name (Legal Business Name): RAYMOND CHAD YEAGER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 TOWER DR STE G
MOORE OK
73160-2388
US

IV. Provider business mailing address

1991 TOWER DR STE G
MOORE OK
73160-2388
US

V. Phone/Fax

Practice location:
  • Phone: 405-735-8282
  • Fax:
Mailing address:
  • Phone: 405-735-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3845
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: