MEDICARE: HARRAH FAMILY CHIROPRACTIC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1083259204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRAH FAMILY CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	PO BOX 215
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-0215
Country	:	US
Telephone Number	:	405-309-2629
Fax Number	:

Provider Business Practice Location Address
First Line	:	19857 NE 23RD ST STE A
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-9307
Country	:	US
Telephone Number	:	405-250-1984
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TYLER KINCAID HADERER
Credential	:	DC
Telephone Number	:	405-250-1984

Provider Enumeration Date	:	11/12/2019
Last Update Date	:	01/14/2026

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