Provider Demographics
NPI:1487661203
Name:CHASE, JOHN GERALD (APRN, CNP, DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GERALD
Last Name:CHASE
Suffix:
Gender:M
Credentials:APRN, CNP, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:BATTLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56515-0547
Mailing Address - Country:US
Mailing Address - Phone:218-862-4325
Mailing Address - Fax:
Practice Address - Street 1:104 MEMORY LANE
Practice Address - Street 2:
Practice Address - City:BATTLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:56515
Practice Address - Country:US
Practice Address - Phone:218-862-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00876111N00000X
AZ7122111N00000X
MNCNP4373363LF0000X
MN5653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNMC3782580OtherCONTROLLED SUBSTANCE REGISTRATION CERTIFICATE