Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO04250 | |
N | 222Z00000X | Podiatrist | CPO04250 | |
Y | 224P00000X | Prosthetist | CPO04250 |
NPI | 1285296293 |
---|---|
Provider Name | Chandler James Balkman |
First Address | Apex, NC 27502-3955 |
Second Address | Apex, NC 27502-3955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2019 |
Last Update Date | 01/07/2019 |