Provider Demographics
NPI:1861595456
Name:DEEMER, EDWARD CARL (DC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:CARL
Last Name:DEEMER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 LAKECREST DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73170-1112
Mailing Address - Country:US
Mailing Address - Phone:405-688-0088
Mailing Address - Fax:
Practice Address - Street 1:832 LAKECREST DR
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73170-1112
Practice Address - Country:US
Practice Address - Phone:405-688-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2009-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
248430201Medicare ID - Type Unspecified
U68478Medicare UPIN