Provider Demographics
NPI:1699141887
Name:OKAMOTO, CASEY S (DC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:S
Last Name:OKAMOTO
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 1:44 N PEARL ST APT 42
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1416
Mailing Address - Country:US
Mailing Address - Phone:608-320-9104
Mailing Address - Fax:
Practice Address - Street 1:44 N PEARL ST APT 42
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1416
Practice Address - Country:US
Practice Address - Phone:608-320-9104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor