Provider Demographics
NPI:1891497020
Name:ISENBERGER, CHASE MICHAEL
Entity Type:Individual
Prefix:MR
First Name:CHASE
Middle Name:MICHAEL
Last Name:ISENBERGER
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 1:538 OLD HIGHWAY 70 4
Mailing Address - Street 2:
Mailing Address - City:WHITE BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:37187-4703
Mailing Address - Country:US
Mailing Address - Phone:608-290-8189
Mailing Address - Fax:
Practice Address - Street 1:538 OLD HIGHWAY 70 4
Practice Address - Street 2:
Practice Address - City:WHITE BLUFF
Practice Address - State:TN
Practice Address - Zip Code:37187-4703
Practice Address - Country:US
Practice Address - Phone:608-290-8189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL085010417363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program