Provider Demographics
NPI:1073201844
Name:HALL, CHASE ANDREW
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:ANDREW
Last Name:HALL
Suffix:
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 1:8059 PLACID WATERS DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-6502
Mailing Address - Country:US
Mailing Address - Phone:248-925-2335
Mailing Address - Fax:
Practice Address - Street 1:8059 PLACID WATERS DR
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-6502
Practice Address - Country:US
Practice Address - Phone:248-925-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program