Provider Demographics
NPI:1629156013
Name:DUVALL, CHAD D (LMP)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:D
Last Name:DUVALL
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 39TH ST NW
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-9519
Mailing Address - Country:US
Mailing Address - Phone:425-802-3378
Mailing Address - Fax:
Practice Address - Street 1:23 S WENATCHEE AVE STE 125
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2285
Practice Address - Country:US
Practice Address - Phone:509-699-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011127225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist