Provider Demographics
NPI:1972554889
Name:LAMER, CHAD RANDALL (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:RANDALL
Last Name:LAMER
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 1:2721 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3857
Mailing Address - Country:US
Mailing Address - Phone:541-754-1577
Mailing Address - Fax:541-754-1577
Practice Address - Street 1:2721 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3857
Practice Address - Country:US
Practice Address - Phone:541-754-1577
Practice Address - Fax:541-754-1577
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS101923Medicare PIN
SD4993035OtherBLUECROSS AND BLUESHIELD
SD7604780Medicaid