Healthcare Provider Details

I. General information

NPI: 1740720325
Provider Name (Legal Business Name): OHIO MUSCULOSKELETAL SPORTS AND SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ALBANY ST
DAYTON OH
45417-3402
US

IV. Provider business mailing address

2136 MCKINLEY AVE
CINCINNATI OH
45224-1832
US

V. Phone/Fax

Practice location:
  • Phone: 937-496-6200
  • Fax:
Mailing address:
  • Phone: 973-369-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHAUNCY L EAKINS
Title or Position: OWNER
Credential: M.D.
Phone: 937-369-4933