Provider Demographics
NPI:1164768677
Name:MARKHAM, CHAD
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:MARKHAM
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 1:6230 NE BLAKEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-9574
Mailing Address - Country:US
Mailing Address - Phone:425-328-5409
Mailing Address - Fax:
Practice Address - Street 1:3888 NW RANDALL WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7847
Practice Address - Country:US
Practice Address - Phone:360-731-8665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60308813225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist