Healthcare Provider Details

I. General information

NPI: 1437130390
Provider Name (Legal Business Name): ROGER L HAMMERSTROM DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 MAIN ST
WOODWARD OK
73801-3121
US

IV. Provider business mailing address

1123 MAIN ST
WOODWARD OK
73801-3121
US

V. Phone/Fax

Practice location:
  • Phone: 580-256-5314
  • Fax: 580-256-5314
Mailing address:
  • Phone: 580-256-5314
  • Fax: 580-256-5314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2101
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: