Provider Demographics
NPI:1710912258
Name:REIGEL, CHAD ALLEN (KCSA)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:ALLEN
Last Name:REIGEL
Suffix:
Gender:M
Credentials:KCSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 AUTUMN BREEZE TRCE
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-1392
Mailing Address - Country:US
Mailing Address - Phone:502-225-6334
Mailing Address - Fax:502-225-6334
Practice Address - Street 1:313 AUTUMN BREEZE TRCE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-1392
Practice Address - Country:US
Practice Address - Phone:502-225-6334
Practice Address - Fax:502-225-6334
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA 059246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist