Provider Demographics
NPI:1104047612
Name:CHANEY, BRUCE ALAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ALAN
Last Name:CHANEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5799 STETSON HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-4223
Mailing Address - Country:US
Mailing Address - Phone:719-471-2273
Mailing Address - Fax:719-380-0228
Practice Address - Street 1:5799 STETSON HILLS BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-4223
Practice Address - Country:US
Practice Address - Phone:719-471-2273
Practice Address - Fax:719-380-0228
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002060363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical