Provider Demographics
NPI:1558410043
Name:CHASE, CLARENCE CHARLES JR (DC)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:CHARLES
Last Name:CHASE
Suffix:JR
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 1:8611 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-4722
Mailing Address - Country:US
Mailing Address - Phone:814-796-2225
Mailing Address - Fax:
Practice Address - Street 1:8611 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-4722
Practice Address - Country:US
Practice Address - Phone:814-796-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001275L111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACH115966Medicare ID - Type Unspecified
PA115966Medicare UPIN