Provider Demographics
NPI:1992215578
Name:DILLINGHAM, CHRIS
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:DILLINGHAM
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 1:2052 PRINCETON RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-4746
Mailing Address - Country:US
Mailing Address - Phone:513-886-7257
Mailing Address - Fax:513-863-9882
Practice Address - Street 1:2052 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4746
Practice Address - Country:US
Practice Address - Phone:513-886-7257
Practice Address - Fax:513-863-9882
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid