Healthcare Provider Details

I. General information

NPI: 1750383741
Provider Name (Legal Business Name): CHRISTOPHER A. COUGHLIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 01/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N WAYNE ST
PIQUA OH
45356-2232
US

IV. Provider business mailing address

215 S GARBER DR
TIPP CITY OH
45371-1183
US

V. Phone/Fax

Practice location:
  • Phone: 937-667-7700
  • Fax: 937-667-5189
Mailing address:
  • Phone: 937-667-7700
  • Fax: 937-667-5189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1680
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: