Provider Demographics
NPI:1982770830
Name:RADER, CALLIE HOWISON (DC)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:HOWISON
Last Name:RADER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-2526
Mailing Address - Country:US
Mailing Address - Phone:304-428-9355
Mailing Address - Fax:304-428-2565
Practice Address - Street 1:923 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-2526
Practice Address - Country:US
Practice Address - Phone:304-428-9355
Practice Address - Fax:304-428-2565
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0895573OtherMEDICARE PTAN
WV2202096000Medicaid
WV1063297OtherCOMP
WV001712610OtherBCBS
U78243Medicare UPIN