Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 001904 | CT |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 38MC00522700 | NJ |
NPI | 1407835622 |
---|---|
Provider Name | Dr. Christopher Robert Chase |
First Address | West Hartford, CT 06119 |
Second Address | West Hartford, CT 06119-1801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2006 |
Last Update Date | 20/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
550846679 | HORIZON BLUE CROSS BLUE SHIELD (01) | NJ |