Healthcare Provider Details

I. General information

NPI: 1174248827
Provider Name (Legal Business Name): CHRISTOPHER GIAUQUE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 HOLIDAY DR
ENGLEWOOD OH
45322-2706
US

IV. Provider business mailing address

75 HOLIDAY DR
ENGLEWOOD OH
45322-2706
US

V. Phone/Fax

Practice location:
  • Phone: 937-771-3012
  • Fax: 937-518-7789
Mailing address:
  • Phone: 937-771-3012
  • Fax: 937-518-7789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: