Provider Demographics
NPI:1497262364
Name:CHIPCHASE, MARK HAINES
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:HAINES
Last Name:CHIPCHASE
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 1:2462 MAGUIRE RD STE 20
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4938
Mailing Address - Country:US
Mailing Address - Phone:407-532-0000
Mailing Address - Fax:
Practice Address - Street 1:2462 MAGUIRE RD STE 20
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4938
Practice Address - Country:US
Practice Address - Phone:407-532-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5227237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist