Provider Demographics
NPI:1366564254
Name:CALLAHAN, MICHAELENE (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAELENE
Middle Name:
Last Name:CALLAHAN
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 1:141 BUCKSKIN LN
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8005
Mailing Address - Country:US
Mailing Address - Phone:407-502-8777
Mailing Address - Fax:
Practice Address - Street 1:141 BUCKSKIN LN
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8005
Practice Address - Country:US
Practice Address - Phone:407-502-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ6091111N00000X
NY9087111N00000X
FLCH12983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ455116314OtherTAX ID
NJ0035815Medicaid
NJ082758Medicare ID - Type UnspecifiedMEDICARE NUMBER