Provider Demographics
NPI:1558987842
Name:MECHAM, CHASE FRED (DC)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:FRED
Last Name:MECHAM
Suffix:
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 1:489 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1822
Mailing Address - Country:US
Mailing Address - Phone:435-896-8820
Mailing Address - Fax:
Practice Address - Street 1:72 W PATRIOT WAY
Practice Address - Street 2:UNIT 1135
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1888
Practice Address - Country:US
Practice Address - Phone:435-289-3444
Practice Address - Fax:435-656-8447
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11788316-1202111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation