Provider Demographics
NPI:1619143096
Name:IRVING, CHESTER
Entity Type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:
Last Name:IRVING
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 1:5411 S MOSLEY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216-3629
Mailing Address - Country:US
Mailing Address - Phone:316-771-7335
Mailing Address - Fax:316-771-7201
Practice Address - Street 1:4031 E HARRY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3724
Practice Address - Country:US
Practice Address - Phone:316-771-7335
Practice Address - Fax:316-771-7201
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care