Provider Demographics
NPI:1124369178
Name:FIFAREK, CHASE STEPHEN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHASE
Middle Name:STEPHEN
Last Name:FIFAREK
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 1:1104 L PAVIA BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-5327
Mailing Address - Country:US
Mailing Address - Phone:517-281-4482
Mailing Address - Fax:
Practice Address - Street 1:12479 S ACCESS RD STE 1
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33981-6206
Practice Address - Country:US
Practice Address - Phone:941-697-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor