Provider Demographics
NPI:1053823153
Name:CHANCE, DANNY GLENN JR
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:GLENN
Last Name:CHANCE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 CYPRESS ST STE 6
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5291
Mailing Address - Country:US
Mailing Address - Phone:318-570-5336
Mailing Address - Fax:318-570-5348
Practice Address - Street 1:3101 CYPRESS ST STE 6
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5291
Practice Address - Country:US
Practice Address - Phone:318-570-5336
Practice Address - Fax:318-570-5348
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician