Provider Demographics
NPI:1790112597
Name:CHANCE, ERIC (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:CHANCE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10050 SW INNOVATION WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2117
Mailing Address - Country:US
Mailing Address - Phone:772-879-8700
Mailing Address - Fax:772-879-8710
Practice Address - Street 1:10050 SW INNOVATION WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2117
Practice Address - Country:US
Practice Address - Phone:772-879-8700
Practice Address - Fax:772-879-8710
Is Sole Proprietor?:No
Enumeration Date:2013-10-11
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor