Provider Demographics
NPI:1487708848
Name:HERSHBERGER, STUART ROSS (D C)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:ROSS
Last Name:HERSHBERGER
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:PERKINS
Mailing Address - State:OK
Mailing Address - Zip Code:74059-0096
Mailing Address - Country:US
Mailing Address - Phone:405-547-1171
Mailing Address - Fax:405-547-4075
Practice Address - Street 1:101 E HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:PERKINS
Practice Address - State:OK
Practice Address - Zip Code:74059-4412
Practice Address - Country:US
Practice Address - Phone:405-547-1171
Practice Address - Fax:405-547-4075
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5749Medicare PIN