Provider Demographics
NPI:1306585971
Name:HOUGLAND, CHAD MICHAEL
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:MICHAEL
Last Name:HOUGLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BEVERLY AVE
Mailing Address - Street 2:2
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-1284
Mailing Address - Country:US
Mailing Address - Phone:740-970-1070
Mailing Address - Fax:
Practice Address - Street 1:401 BEVERLY AVE APT 2
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1284
Practice Address - Country:US
Practice Address - Phone:740-970-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program