Provider Demographics
NPI:1447640735
Name:CALLAGHAN, CATHERINE MARISA (DC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARISA
Last Name:CALLAGHAN
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 1:11500 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-2197
Mailing Address - Country:US
Mailing Address - Phone:407-658-6500
Mailing Address - Fax:
Practice Address - Street 1:11500 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-2197
Practice Address - Country:US
Practice Address - Phone:407-658-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor