MEDICARE: DR. THONGKHAM VANNARATH D.C.

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	3485	OK

General Provider Information

NPI Number	:	1841475787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THONGKHAM VANNARATH D.C.

Provider Business Mailing Address
First Line	:	2404 NW 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2408
Country	:	US
Telephone Number	:	405-521-0001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 NW 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2408
Country	:	US
Telephone Number	:	405-521-0001
Fax Number	:

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

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	04/29/2008

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