Provider Demographics
NPI:1164997326
Name:CHASE, PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:CHASE
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 1:311 E COEUR D ALENE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4965
Mailing Address - Country:US
Mailing Address - Phone:208-991-0229
Mailing Address - Fax:
Practice Address - Street 1:311 E COEUR D ALENE AVE STE B
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4965
Practice Address - Country:US
Practice Address - Phone:208-991-0229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHAI-1870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDCHAI-1870OtherSTATE OF IDAHO CHIROPRACTIC BOARD