Provider Demographics
NPI:1518658590
Name:THOMAS, CHESTER LEE JR
Entity Type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:LEE
Last Name:THOMAS
Suffix:JR
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 1:3329 PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46409-1026
Mailing Address - Country:US
Mailing Address - Phone:219-316-2214
Mailing Address - Fax:
Practice Address - Street 1:3329 PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46409-1026
Practice Address - Country:US
Practice Address - Phone:219-316-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN6550017256347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle