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General NPI Number Information
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NPI Number | 1912471244
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Entity Type | Individual
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Provider Name | TYLER KINCAID HADERER DC
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Gender | Male
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Dates
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Enumeration Date | 01/21/2019
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 19857 NE 23RD ST STE A
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City | HARRAH
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State | OK
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Zip | 73045-9307
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Country | US
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Telephone | 405-309-2629
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 215
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City | HARRAH
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State | OK
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Zip | 73045-0215
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Country | US
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Telephone | 405-309-2629
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4314
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License Number State | OK
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