Provider Demographics
NPI:1053469692
Name:WASSON, CHAD D (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:D
Last Name:WASSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 N NAPERVILLE WHEATON RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1557
Mailing Address - Country:US
Mailing Address - Phone:630-848-1708
Mailing Address - Fax:630-566-1585
Practice Address - Street 1:1555 N NAPERVILLE WHEATON RD
Practice Address - Street 2:SUITE 206
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1557
Practice Address - Country:US
Practice Address - Phone:630-848-1708
Practice Address - Fax:630-566-1585
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008808111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU75744Medicare UPIN
ILK25364Medicare PIN