Healthcare Provider Details

I. General information

NPI: 1487708848
Provider Name (Legal Business Name): STUART ROSS HERSHBERGER D. C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 10/04/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E HIGHWAY 33
PERKINS OK
74059-4412
US

IV. Provider business mailing address

PO BOX 96
PERKINS OK
74059-0096
US

V. Phone/Fax

Practice location:
  • Phone: 405-547-1171
  • Fax: 405-547-4075
Mailing address:
  • Phone: 405-547-1171
  • Fax: 405-547-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2294
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: