Provider Demographics
NPI:1659354470
Name:CHANDLER, JEFFREY L (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N 2ND ST
Mailing Address - Street 2:STE 301
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6131
Mailing Address - Country:US
Mailing Address - Phone:208-344-3324
Mailing Address - Fax:208-344-4349
Practice Address - Street 1:222 N 2ND ST
Practice Address - Street 2:STE 301
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6131
Practice Address - Country:US
Practice Address - Phone:208-344-3324
Practice Address - Fax:208-344-4349
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP-73213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID480033367OtherRAILROAD MEDICARE
ID003517000Medicaid
ID4182810001Medicare NSC
ID1350527Medicare ID - Type Unspecified
ID1350528Medicare PIN
ID003517000Medicaid