Provider Demographics
NPI:1124305164
Name:HALDEMAN, CHAN BAO (DC)
Entity type:Individual
Prefix:MRS
First Name:CHAN
Middle Name:BAO
Last Name:HALDEMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CHAN
Other - Middle Name:
Other - Last Name:HALDEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1796 MARION WALDO RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-7428
Mailing Address - Country:US
Mailing Address - Phone:419-689-3887
Mailing Address - Fax:
Practice Address - Street 1:1796 MARION WALDO RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-7428
Practice Address - Country:US
Practice Address - Phone:419-689-3887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC 4216111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor