Provider Demographics
NPI:1942677109
Name:VIFQUAIN, CHASE JORDANE (DC)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:JORDANE
Last Name:VIFQUAIN
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 1:319 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2333
Mailing Address - Country:US
Mailing Address - Phone:816-524-7000
Mailing Address - Fax:816-524-0168
Practice Address - Street 1:319 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2333
Practice Address - Country:US
Practice Address - Phone:816-524-7000
Practice Address - Fax:816-524-0168
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015024930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor