Healthcare Provider Details

I. General information

NPI: 1255500583
Provider Name (Legal Business Name): RICHARD L CHAMBERLAIN DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E 2ND ST
FRANKLIN OH
45005-1700
US

IV. Provider business mailing address

909 E 2ND ST
FRANKLIN OH
45005-1700
US

V. Phone/Fax

Practice location:
  • Phone: 937-746-8357
  • Fax: 937-746-1992
Mailing address:
  • Phone: 937-746-8357
  • Fax: 937-746-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOH34-00-4313C
License Number StateOH

VIII. Authorized Official

Name: RICHARD L CHAMBERLAIN
Title or Position: D.O.
Credential: D.O.
Phone: 937-746-8357