Provider Demographics
NPI:1629323829
Name:CALLAHAN CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:CALLAHAN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-879-2209
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:CALLAHAN
Mailing Address - State:FL
Mailing Address - Zip Code:32011-1107
Mailing Address - Country:US
Mailing Address - Phone:904-879-2209
Mailing Address - Fax:904-879-3709
Practice Address - Street 1:542184 S. KINGS RD.
Practice Address - Street 2:SUITE 3B
Practice Address - City:CALLAHAN
Practice Address - State:FL
Practice Address - Zip Code:32011-1107
Practice Address - Country:US
Practice Address - Phone:904-879-2209
Practice Address - Fax:904-879-3709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 1521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty