MEDICARE: DR. ANTHONY VINCENT GUADAGNO DC

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	1178	OK

General Provider Information

NPI Number	:	1679634489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY VINCENT GUADAGNO DC

Provider Business Mailing Address
First Line	:	5115 NW 16
Second Line	:
City	:	OKLA CITY
State	:	OK
Zip	:	73127-2807
Country	:	US
Telephone Number	:	405-949-1194
Fax Number	:

Provider Business Practice Location Address
First Line	:	5115 NW 16
Second Line	:
City	:	OKLA CITY
State	:	OK
Zip	:	73127-2807
Country	:	US
Telephone Number	:	405-949-1194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. ANTHONY VINCENT GUADAGNO DC” Practice Location

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