Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH13419 | FL |
NPI | 1003408576 |
---|---|
Provider Name | Michael Callahan |
First Address | Apopka, FL 32712-2023 |
Second Address | Clermont, FL 34711-6699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2021 |
Last Update Date | 06/02/2021 |