Healthcare Provider Details

I. General information

NPI: 1356837215
Provider Name (Legal Business Name): MR. CHRISTOPHER HANSON SYKES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 WOODBOURNE TRL
DAYTON OH
45459-2903
US

IV. Provider business mailing address

639 WOODBOURNE TRL
DAYTON OH
45459-2903
US

V. Phone/Fax

Practice location:
  • Phone: 937-423-6399
  • Fax:
Mailing address:
  • Phone: 937-423-6399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: