Provider Demographics
NPI:1649776089
Name:CHAVARRIA, JOSE JR
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:CHAVARRIA
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 1:3827 W BELLA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-1028
Mailing Address - Country:US
Mailing Address - Phone:316-992-9350
Mailing Address - Fax:
Practice Address - Street 1:100 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-2443
Practice Address - Country:US
Practice Address - Phone:620-229-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer