Provider Demographics
NPI:1457689093
Name:BAXTER, CHASE RYAN (HID, HIS)
Entity Type:Individual
Prefix:MR
First Name:CHASE
Middle Name:RYAN
Last Name:BAXTER
Suffix:
Gender:M
Credentials:HID, HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5526
Mailing Address - Country:US
Mailing Address - Phone:817-613-8740
Mailing Address - Fax:
Practice Address - Street 1:1211 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5526
Practice Address - Country:US
Practice Address - Phone:817-613-8740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80294237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist