Healthcare Provider Details

I. General information

NPI: 1639468648
Provider Name (Legal Business Name): RYNE SHAFER PA-C, D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 N WESTERN AVE STE 200
OKLAHOMA CITY OK
73114-1431
US

IV. Provider business mailing address

13100 N WESTERN AVE STE 200
OKLAHOMA CITY OK
73114-1431
US

V. Phone/Fax

Practice location:
  • Phone: 800-781-1220
  • Fax:
Mailing address:
  • Phone: 800-781-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4145
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3225
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: