Provider Demographics
NPI:1841512860
Name:CALLAHAN, ROBERT RYAN (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RYAN
Last Name:CALLAHAN
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 1:8384 BAYMEADOWS RD STE 3
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7486
Mailing Address - Country:US
Mailing Address - Phone:904-731-3370
Mailing Address - Fax:
Practice Address - Street 1:8384 BAYMEADOWS RD STE 3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7486
Practice Address - Country:US
Practice Address - Phone:904-731-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9909111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor