Basic Information
| Provider Information | |||||||||
| NPI: | 1801524756 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLINE | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | CALEB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1945 SCOTTSVILLE RD B2 PMB 137 | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707820434 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1801 ASHLEY CIR | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421043362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707931000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2022 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | TSA033 | KY | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.