Provider Demographics
NPI:1750464400
Name:GEDEON, CHRISTIAN ERNEST (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ERNEST
Last Name:GEDEON
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:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-1554
Mailing Address - Country:US
Mailing Address - Phone:740-385-4141
Mailing Address - Fax:740-385-3838
Practice Address - Street 1:12886 GREY ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1831
Practice Address - Country:US
Practice Address - Phone:740-385-4141
Practice Address - Fax:740-385-3838
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2314070Medicaid
OH2314070Medicaid
OH4141Medicare PIN