Provider Demographics
NPI:1891298212
Name:COLEMAN, CHUCK CRIS
Entity Type:Individual
Prefix:
First Name:CHUCK
Middle Name:CRIS
Last Name:COLEMAN
Suffix:
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 1:34130 BURTON FARM RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19945-2951
Mailing Address - Country:US
Mailing Address - Phone:302-228-8025
Mailing Address - Fax:302-380-7700
Practice Address - Street 1:34130 BURTON FARM RD
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:DE
Practice Address - Zip Code:19945-2951
Practice Address - Country:US
Practice Address - Phone:302-228-8025
Practice Address - Fax:302-380-7700
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2013600229171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications