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General NPI Number Information
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NPI Number | 1528532611
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Entity Type | Individual
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Provider Name | CHAD ELLIOTT CALLAHAN
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Gender | Male
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 01/11/2019
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Provider Practice Location Address
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Address Line | 5790 DENLINGER RD
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City | DAYTON
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State | OH
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Zip | 45426-1838
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Country | US
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Telephone | 937-219-1567
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Fax |
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Provider Business Mailing Address
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Address Line | 10972 SHALLOW CREEK CT
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City | CENTERVILLE
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State | OH
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Zip | 45458-7500
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PTA010209
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License Number State | OH
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