Provider Demographics
NPI:1750383741
Name:COUGHLIN, CHRISTOPHER A (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:COUGHLIN
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 1:215 S GARBER DR
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-1183
Mailing Address - Country:US
Mailing Address - Phone:937-667-7700
Mailing Address - Fax:937-667-5189
Practice Address - Street 1:404 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-2232
Practice Address - Country:US
Practice Address - Phone:937-667-7700
Practice Address - Fax:937-667-5189
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2016-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341701641-01OtherBWC
OH0869421Medicaid
OHU28761Medicare UPIN
OHCO0711431Medicare ID - Type Unspecified
OHCO0711432Medicare ID - Type Unspecified