Provider Demographics
NPI:1114781069
Name:SHILLINGBURG, CHAD R
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:R
Last Name:SHILLINGBURG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3383 CURTIS ST
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-1007
Mailing Address - Country:US
Mailing Address - Phone:330-701-3688
Mailing Address - Fax:
Practice Address - Street 1:3383 CURTIS ST
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-1007
Practice Address - Country:US
Practice Address - Phone:330-701-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications