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General NPI Number Information
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NPI Number | 1629323829
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Entity Type | Organization
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Legal Business Name | CALLAHAN CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 07/13/2012
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 542184 S. KINGS RD. SUITE 3B
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City | CALLAHAN
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State | FL
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Zip | 32011-1107
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Country | US
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Telephone | 904-879-2209
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Fax | 904-879-3709
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Provider Business Mailing Address
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Address Line | PO BOX 1107
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City | CALLAHAN
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State | FL
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Zip | 32011-1107
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Country | US
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Telephone | 904-879-2209
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Fax | 904-879-3709
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. DANIEL R. WEAVER
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Credential | D.C.
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Telephone | 904-879-2209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH 1521
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License Number State | FL
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