=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326260548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIROPRACTIC HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1123 MAIN STREET
-----------------------------------------------------
City | WOODWARD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-256-5314
-----------------------------------------------------
Fax | 580-256-5314
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1123 MAIN STREET
-----------------------------------------------------
City | WOODWARD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-256-5314
-----------------------------------------------------
Fax | 580-256-5314
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROGER L HAMMERSTROM
-----------------------------------------------------
Credential | DR
-----------------------------------------------------
Telephone | 580-256-5314
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2101
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------