Provider Demographics
NPI:1346247194
Name:CHANDLER, THAD J (DC)
Entity Type:Individual
Prefix:
First Name:THAD
Middle Name:J
Last Name:CHANDLER
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 1:924 3RD ST S
Mailing Address - Street 2:SUITE A
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-3817
Mailing Address - Country:US
Mailing Address - Phone:208-461-6523
Mailing Address - Fax:208-461-9130
Practice Address - Street 1:924 3RD ST S
Practice Address - Street 2:SUITE A
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3817
Practice Address - Country:US
Practice Address - Phone:208-461-6523
Practice Address - Fax:208-461-9130
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-05-20
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
IDCHIA879111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDU79468Medicare UPIN