MEDICARE: CARDER CHIROPRACTIC CLINIC, INC.

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	1414	OK

General Provider Information

NPI Number	:	1184751224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDER CHIROPRACTIC CLINIC, INC.

Provider Business Mailing Address
First Line	:	1008 S ROCK ISLAND AVE
Second Line	:
City	:	EL RENO
State	:	OK
Zip	:	73036-4757
Country	:	US
Telephone Number	:	405-262-0548
Fax Number	:	405-262-5232

Provider Business Practice Location Address
First Line	:	1008 S ROCK ISLAND AVE
Second Line	:
City	:	EL RENO
State	:	OK
Zip	:	73036-4757
Country	:	US
Telephone Number	:	405-262-0548
Fax Number	:	405-262-5232

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KENT ELLIS CARDER
Credential	:	D.C.
Telephone Number	:	405-262-0548

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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