Provider Demographics
NPI:1639682495
Name:DORAN, CHRISTOPHER SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:SCOTT
Last Name:DORAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-2772
Mailing Address - Country:US
Mailing Address - Phone:920-337-0103
Mailing Address - Fax:920-338-9066
Practice Address - Street 1:1224 OCALA RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-1548
Practice Address - Country:US
Practice Address - Phone:850-576-2129
Practice Address - Fax:850-576-2129
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5386-12111N00000X
FLCH12345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor