Provider Demographics
NPI:1013649581
Name:FORD, CHANCE DANIEL
Entity Type:Individual
Prefix:
First Name:CHANCE
Middle Name:DANIEL
Last Name:FORD
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 1:416 HESLIP ST
Mailing Address - Street 2:
Mailing Address - City:PELAHATCHIE
Mailing Address - State:MS
Mailing Address - Zip Code:39145-2990
Mailing Address - Country:US
Mailing Address - Phone:662-582-3900
Mailing Address - Fax:
Practice Address - Street 1:7455 W WASHINGTON AVE STE 302
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4340
Practice Address - Country:US
Practice Address - Phone:662-582-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic